Body composition assessment includes the parameter skeletal muscle mass, subcutaneous and visceral adipose tissue (SAT and VAT). The purpose of this study was to elucidate associations of body composition parameters with mortality in patients with acute bleeding undergoing transarterial embolization (TAE).

A mixed cohort of patients from 2018 to 2022 with acute bleeding requiring treatment with a TAE was retrospectively evaluated. In every case, the triphasic CT to diagnose the source of bleeding was used to calculate the body composition parameters.

A total of 251 patients (93 female, 37.1%) with a mean age of 65.5 ± 14.3 years, 30-d mortality of 40.2%, and 24-h mortality of 7.6% were included in the analysis. In the Cox regression analysis, no statistically significant correlations were found between the body composition parameters and 24-h or 30-day mortality. In the subgroup analysis of patients aged older than 65 years, skeletal muscle index was associated with short-term 24-h mortality HR of 0.95 (95% CI 0.90; 0.99, P = .035).

The present study demonstrated the prognostic impact of clinical, laboratory, aniography-related, and CT-defined body composition in patients with acute haemorrhage undergoing endovascular therapy. Although the overall effect of CT-defined body composition appears to be small, skeletal muscle index was a prognostic factor in the age group over 65 years.

This is a large single-centre study to investigate the prognostic relevance of CT-defined body composition in patients undergoing TAE. The effect is overall small but might be further investigated in older patients in further trials.

We performed this systematic review and dose-response meta-analysis of randomized clinical trials (RCTs) to determine the effects of oral nutritional supplements (ONS) in cancer patients undergoing chemo (radio) therapy on body weight, body mass index (BMI), serum albumin, fatigue, quality of life (QOL), patient-generated subjective global assessment (PG-SGA) score and C-reactive protein (CRP).

Appropriate search terms were used for systematic search in PubMed, Scopus, and Web of Science, till April 2024. Both pairwise and dose-response meta-analyses were done. Random effects model was applied for analyses.

We found that ONS administration significantly improved weight gain [weighted mean difference (WMD): 1.18 kg; 95 % CI, 0.20 to 2.17, P = 0.019; I2 = 56.2 %, PQ-test = 0.002], fatigue scores [standard mean difference (SMD): -1.45; 95 % CI, -2.48 to -0.42, P = 0.006; I2 = 90.1 %, PQ-test< 0.001], PG-SGA scores (WMD: -1.11; 95 % CI, -2.93 to 0.70, P = 0.229; I2 = 72.4 %, PQ-test = 0.001), and QOL (SMD: 1.38; 95 % CI, 0.45 to 2.31; P < 0.001; I2 = 94.4 %, PQ-test< 0.001). The dose-response meta-analysis found a significant relationship between each 200 ml/d increase in ONS and improvement in fatigue (SMD: -7.30; 95 % CI, -10.17 to -4.42, P < 0.001; I2 = 97 %, PQ-test< 0.001) and QOL scores (SMD:7.01; 95 % CI, 3.89 to 10.12, P = 0.001; I2 = 98.3 %, PQ-test < 0.001). Based on a non-linear dose-response meta-analysis, the most significant reduction in fatigue was observed at ONS dosages of ≥400 ml/day, while the most significant improvement in QOL score was seen at ≥ 500 ml/day dosages. Our analysis also showed a significant association between higher albumin levels and ONS intake of ≥200 ml daily.

In conclusion, ONS can help improve various cancer-related complications; however, further good-quality research is still needed. The study found that ONS significantly improves QoL, reduces fatigue, and promotes body weight gain in cancer patients. However, there were no significant effects on BMI, serum albumin, CRP, or PG-SGA scores.

Body composition has emerged as a significant determinant of cancer patient outcomes, with computed tomography (CT) assessment at the L3 level offering a reliable evaluation method. While muscle mass and adiposity have been linked to poorer outcomes in hematological malignancies, their impact remains unstudied in adults with acute lymphoblastic leukemia (ALL).

This retrospective single-center study enrolled adults newly diagnosed with ALL. Skeletal muscle, visceral, and subcutaneous fat areas were quantified. Low muscle mass was defined as a skeletal muscle index (SMI) less than 55 cm2/m2 in men, and less than 39 cm2/m2 in women, and receiver operating characteristic curves determined cutoff points for SMI, subcutaneous adipose tissue index (SATI) and visceral adipose tissue index (VATI) correlated with mortality.

Ninety patients were included. Low muscle mass was associated with mortality in patients treated with a pediatric inspired regimen (PIR) (HR 4.92, 95 % CI [1.38-17.57], p = 0.014) and lower median SMI was observed in patients who died during induction (p = 0.016). High visceral adiposity (HR 1.89, 95 % CI [1-3.57], p = 0.049) and high subcutaneous adiposity (HR 1.99, 95 % CI [1-3.96], p = 0.05) were also associated with mortality in the whole population. Furthermore, a higher VATI was observed in patients who developed an infectious episode during induction (p = 0.03), and a higher VATI was observed in patients who were treated with a PIR who had measurable residual disease positivity after induction chemotherapy (p = 0.044).

CT-assessed muscle mass, and adiposity bear prognostic significance in newly diagnosed ALL patients.

Radical resection combined with prophylactic hyperthermic intraperitoneal chemotherapy (p-HIPEC) is a promising treatment for locally advanced gastric cancer (LAGC), though factors influencing its long-term benefits remain unclear. This study aimed to assess the impact of computed tomography (CT)-based body composition parameters on survival in patients undergoing this combination treatment, exploring nutritional factors affecting long-term survival and developing a prognostic model.

We retrospectively analyzed clinical and CT data from 230 patients with LAGC who underwent radical resection with p-HIPEC between January 2017 and December 2020. Cox regression and Kaplan-Meier analysis were used to identify independent risk factors, and nomograms were constructed based on significant predictors. The models' accuracy was evaluated using receiver operating characteristic (ROC) curves and calibration plots.

Of the 230 patients, the 3-year survival rate was 56.1%, with a median overall survival of 49.7 months. Multivariate analysis identified sarcopenia (hazard ratio [HR], 3.078; p < 0.001), low subcutaneous adipose tissue index (HR, 1.739; p = 0.002), high visceral-to-subcutaneous adipose tissue ratio (HR, 1.746; p = 0.002), pT stage (p < 0.001), pN stage (N3: p = 0.004; N2: p = 0.049), and vascular invasion (p < 0.001) as independent risk factors for poor survival. Nomograms incorporating body composition and tumor features predicted 1-, 3-, and 5-year overall survival with high accuracy (AUC >0.7).

Body composition and tumor characteristics are independent predictors of overall survival in LAGC patients. Nomograms integrating these factors provide reliable prognostic predictions.

The objective of this study was to investigate the association of radiological sarcopenia and frailty with postoperative outcomes in adult patients undergoing oncological surgery.

Data were derived from the PICNIC study, consisting of two consecutive series of patients undergoing surgical cancer treatment. Radiological sarcopenia was assessed based on CT imaging. The presence of low muscle mass and/or low muscle density was determined based on lowest quartile gender specific cut-off values. Frailty was defined by a score of ≥4 on the Groningen frailty index. Postoperative overall survival was analysed with Kaplan-Meier curves and Logrank testing. Multivariable Cox regression analyses adjusted for age and gender were performed to calculate adjusted hazard ratios (HR).

A total of 372 patients were included. Median age was 69 (28-86) years, 77 patients (23.5%) were frail and radiological sarcopenia was present in 134 patients (41.0%). Combined radiological sarcopenia and frailty was present in 35 patients (10.7%). One-year (65.6% versus 87.0%) and three-year survival (31.4% versus 66.8%) were significantly worse in patients with combined radiological sarcopenia and frailty. The combined presence of radiological sarcopenia and frailty was associated with significantly decreased overall survival (HRadjusted: 2.06, 95% CI: 1.39-3.05, P < .001).

Co-occurrence of radiological sarcopenia and frailty is strongly related to impaired survival in surgical cancer patients.

The combined presence of radiological sarcopenia and frailty is associated with decreased postoperative survival, strongly exceeding the effects of both risk factors separately. The use of radiological sarcopenia in addition to frailty screening can further optimize preoperative risk stratification.

Malnutrition commonly affects patients with oral squamous cell carcinoma (OSCC), which contributes to worsening prognosis. Moreover, specific strategies for diagnosing and managing malnutrition in OSCC are lacking. We aimed to investigate if the modality of nutritional treatment as standard oral (ON) or artificial enteral nutrition (AN), assigned by a dedicated nutritional team or not, influences survival in patients with OSCC. Moreover, given the difficulties in obtaining adequate nutritional evaluation in patients with OSCC we preliminary evaluated the magnetic resonance imaging volumetric reconstruction of posterior paraspinal muscles at the level of the third cervical vertebra (MRI-C3) as a tentative new approach to investigate sarcopenia.

This retrospective study included 52 consecutive patients with OSCC who underwent surgery at the University Hospital of Palermo (I) from Jan 2020 to May 2023. In-hospital nutritional support was provided by a dedicated team. The patients were retrospectively compared with a control group of 11 patients who were surgically treated for OSCC between January and December 2019 in the same unit of surgery, in the absence of a dedicated nutritional team. Upon discharge, the nutritional treatment consisted of ON or AN. In 2020-2023, industrially produced special medical food formulations were used rather than natural foods as it was in use in 2019; also, adequate protein supplements were assigned in order to reach the recommended protein intake of 1-0-1.2 g/kg ideal body weight. The MRI-C3 volumetric reconstruction was obtained in 16 patients.

As per-protocol, the patients were categorized according to pre-surgery TNM stage: groups A (TNM stages I-III) and B (IVa-IVc). The prevalence of group A patients was 59.6% in the case group and 85.7% in the control group (p < 0.001), with higher survival rates at follow-up in the control group (80.5% vs. 27.3%), therefore, the two historical groups were not comparable. Given the limited number of cases, all patients were included in a unique group. Advanced stages of OSCC (log-rank test, p < 0.001) and AN (p < 0.001) were independently associated with a lower survival rates. The 3-12 month post-surgery MRI_C3 volume increased in patients who received ON treatment and decreased in those who received AN treatment (p < 0.001).

AN is associated with lower survival probability than ON in patients with OSCC. The MRI-C3 measurement of paravertebral muscles is a promising technique for detecting sarcopenia that needs to be confirmed by further studies including larger groups of patients.

As the number of cancer cases is increasing dramatically worldwide, patients with cancer are facing serious threats of nutritional loss, sarcopenia, and even cachexia in the early stages of the disease. Sarcopenia is closely associated with poor prognosis of patients with cancer; however, there is a significant gap in the current clinical knowledge of tumor-related sarcopenia and the means to prevent and control it. The aim of this study is to explore the prevalence and influencing factors of tumor-related sarcopenia through a scoping review, and to provide guidance for future research directions and the development of intervention protocols.

Using computerized search methods, we extensively searched multiple authoritative databases, including CNKI, Wanfang Database, FMRS, Cochrane Library, PubMed, Embase, Web of Science, Scopus, and BMJ, with a search time limit from the establishment of the databases to July 16, 2024. Systematic data extraction, integration, and analysis were performed on the included studies, and the research results were finally summarized and reported.

A total of 22 papers involving 20069 patients with cancer were included, and the prevalence of sarcopenia ranged from 8% to 84.96%. There were 54 influencing factors of tumor-related sarcopenia, risk factors including low BMI, advanced age, male sex, and TNM stage IV, and associated factors including NRS2002 score ≥ 3, long-term smoking history, diabetes mellitus, tumor size more than 4 cm, and lymph node metastases.

The prevalence of tumor-related sarcopenia is high and influenced by numerous factors, and most of the literature included in this review were cross-sectional and retrospective studies. Future studies urgently need to adopt a more rigorous longitudinal design in order to deeply investigate the causal relationship between factors and sarcopenia, and further exploration of factors with unclear mechanisms is needed, as well as to carry out intervention studies based on this group, in order to delay or even stop the sarcopenia development process and improve the prognostic quality of patients with cancer.

The impact of epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors (TKIs) on muscle mass in individuals with advanced lung cancer has yet to be fully delineated. This study aimed to examine the dynamics of skeletal muscle mass during EGFR-TKIs targeted therapy, elucidate its clinical relevance, and explore the potential mechanisms.

We retrospectively recruited 104 patients with EGFR-mutant advanced lung adenocarcinoma who received icotinib or afatinib as first-line treatment. Skeletal muscle changes were assessed by abdominal CT obtained before and during treatment with EGFR-TKIs. The mean interval (± SD) between two CT scans was 109 days (± 16 days). Targeted panel sequencing of tumor tissue was used to detect genetic alterations. Functional enrichment analysis of genes interacting with EGFR-TKIs and muscle loss was performed to elucidate the potential toxicological mechanisms.

A total of 42 (40.4%) patients experienced muscle loss during targeted therapy. Genetic analysis indicated muscle loss group had a higher proportion of MDM2 amplification and PIK3CA alterations (p = 0.011 & p = 0.045, respectively).Patients with baseline low muscle density and experienced ≥ Grade 2 diarrhea had higher rate of muscle loss (p = 0.005 & p < 0.001, respectively). Multivariate analysis revealed that muscle loss was independently associated with shorter PFS (hazard ratio [HR] 1.86, 95% confidence interval [CI]: 1.09 ∼ 3.18; p = 0.023). Besides, we found genes associated with icotinib, afatinib and muscle loss were significantly enriched in MAPK signaling pathway and calcium signaling pathway.

This study highlights the high prevalence and detrimental impact of muscle loss during EGFR-TKIs treatment.

Older patients with cancer (65 years and older) are a growing population with unique nutrition-and treatment-related issues that accelerate aging. Nutrition interventions attenuate nutritional decline, muscle loss, and risk of malnutrition and sarcopenia in patients with cancer, however the evidence for older patients with cancer is limited. The aim of this systematic review was to evaluate the efficacy of nutrition interventions on nutritional status, body weight/composition and clinical outcomes in older patients with cancer and to identify future research priority areas.

Three databases were systematically searched from inception until January 2024. Eligible studies were randomised controlled trials (RCT) evaluating a nutrition intervention in older patients with cancer that reported nutrition-related and clinical outcomes. Studies including older patients were determined by the mean age ≥ 65 years with the error to the mean > 60 years. Between-group differences in nutritional and clinical outcomes were extracted.

Eleven studies describing nine RCTs were included in this review. Three trials specifically included patients 65 years and older. Most interventions intended to reduce malnutrition risk across a mix of cancer types and treatments, and one trial was designed to reduce comorbidities after treatment. Changes in dietary intake (n = 4), nutrition status (n = 1), weight (n = 5), and muscle mass (n = 3) were inconsistently reported, but preliminary evidence showed dietary counselling with oral nutrition supplements (ONS) resulted in improved weight maintenance in patients with pancreatic cancer. There was limited evidence of a benefit from nutrition interventions on treatment tolerance or quality of life. The heterogeneous findings in methodological design, including dietary prescription and frequency of consultations and reporting of outcomes, inhibits evidence-based recommendations for older adults with cancer.

Nutrition interventions designed specifically to address nutrition-related issues unique to older patients with cancer is a clear research priority. Research specifically targeting older patients post treatment, a period during which treatment-related side effects still occur, is limited. To support the growing population of older patients with cancer, future research must consistently report the dietary prescription, adherence to nutritional requirements, and clearly-defined nutrition-related parameters and clinical outcomes that are specific to older patients.

Sarcopenia, defined as skeletal muscle loss, is thought to be a hallmark of cancer cachexia. It has an impact on mortality, especially in cancer patients. There are also opposing views regarding the relationship between definitive concurrent chemoradiotherapy (CRT) and sarcopenia in locally advanced lung cancer. Our aim was to investigate the prognostic effect of sarcopenia in our patients with locally advanced stage III non-small cell lung cancer (NSCLC) who received definitive concurrent CRT by using many markers, and to determine the overall survival (OS). The study was designed as a retrospective cohort. 54 patients with stage III NSCLC who received definitive concurrent CRT at the Radiation Oncology Unit of Health Sciences University Izmir Dr Suat Seren Chest Diseases and Surgery Training Hospital, between January 1, 2018 and December 31, 2019, were included in the study.92% of our patients were sarcopenic with international L3-skeletal muscle index (SMI) and Psoas muscle index (PMI) threshold values. The mean OS time was 32.4 months, and the 4-year survival rate was 38.9%. While the new threshold values specific to our patient group were 26.21 for SMI and 2.94 for PMI, SMI and PMI did not indicate OS with these values. Even with the new values, most proposed criteria for sarcopenia did not indicate OS. However, low BMI (≤21.30), low serum albumin (≤4.24 mg/dl) and low visceral fat tissue area (≤37) in univariate analysis, and low visceral fat tissue area (≤37) in multivariate analysis indicated OS. OS was poor in patients with low fat tissue area. In patients with stage III NSCLC who received definitive concurrent CRT, low visceral fat tissue area (≤37) indicated OS, rather than SMI, PMI and other sarcopenia indices.

Sarcopenia, characterized by progressive loss of skeletal muscle mass and strength, is a prevalent but often overlooked condition in patients with cancer who are terminally ill. It contributes to functional decline, increased symptom burden, and reduced quality of life, yet remains underrecognized in palliative care. Diagnosing sarcopenia in this population is challenging because conventional imaging techniques are often impractical. Instead, alternative assessments, such as the Strength, Assistance with walking, Rise from a chair, Climb stairs, and Falls questionnaire (SARC-F), anthropometric measurements, and bioelectrical impedance analysis offer feasible options. Management should focus on symptom relief, functional preservation, and patient comfort, rather than on muscle mass restoration. Nutritional support must be tailored to prognosis, with aggressive interventions generally avoided during end-of-life care. Although exercise may help to maintain mobility and alleviate symptoms, its feasibility is often limited. Pharmacological interventions, including appetite stimulants and anti-cachexia agents, remain largely investigational, with insufficient evidence for routine use in palliative care. Future research should refine sarcopenia assessment methods and develop patient-centered interventions that align with palliative care principles, emphasizing quality of life and individualized needs.

Due to malnutrition and tumor cachexia, body composition (BC) is frequently altered and known to adversely affect short- and long-term results in patients with cholangiocarcinoma (CCA). Here, we explored immune cell populations in the tumor and liver of CCA patients with respect to BC.

A cohort of 96 patients who underwent surgery for CCA was investigated by multiplexed immunofluorescence (MIF) techniques with computer-based analysis on whole-tissue slide scans to quantify and characterize immune cells in normal liver and tumor regions. BC was characterized by obesity, sarcopenia, myosteatosis, visceral obesity and sarcopenic obesity. Associations between BC and immune cell populations were determined by univariate and multivariable binary logistic regressions.

BC was frequently altered in intrahepatic CCA (iCCA, n = 48), with 47.9% of the patients showing obesity, 70.8% sarcopenia, 18.8% sarcopenic obesity, 58.3% myosteatosis and 54.2% visceral obesity as well as in perihilar CCA (pCCA, n = 48) with 45.8% of the patients showing obesity, 54.0 sarcopenia, 14.6% sarcopenic obesity, 47.9% myosteatosis and 56.3% visceral obesity. From an immune cell perspective, independent associations within the tumor compartment were observed for iCCA (myosteatosis: TIM-3+CD8+cells; obesity: PD-1+TIM-3+CD4+cells) and for pCCA (myosteatosis: PD-L2+CD68-cells and CD4+cells). Further, independent associations were observed within the normal liver parenchyma for iCCA (visceral obesity: PD-1+PD-L1+PD-L2+CD68+cells) and for pCCA (sarcopenia: CD68+cells and TIM-3+CD8+cells; visceral obesity: ICOS+-TIGIT+CD8+cells and sarcopenic obesity: PD-1+PD-L1+PD-L2+CD8+cells).

This is the first systematic analysis of the association of BC and immune cells in cholangiocarcinoma showing a strong association between BC and distinct immune cell populations within the tumor itself as well as within the normal parenchyma.

FOLFIRINOX, a primary chemotherapy for metastatic pancreatic cancer, often causes severe toxicity, necessitating hospitalization and dose adjustments. This study aims to identify predictors of FOLFIRINOX toxicity, focusing on biological, clinical, and anthropometric factors.

This retrospective study analyzes pancreatic adenocarcinoma patients on FOLFIRINOX, assessing pre-treatment biological, clinical, and anthropometric traits. Hospitalizations and tolerance during the first chemotherapy month were evaluated using CTCAE v5.0 grading, with early toxicity assessed via anthropometric factors using Anthropometer3DNet software from pre-treatment scans.

In 152 pancreatic cancer patients (median age: 62), FOLFIRINOX was administered in metastatic (81%), locally advanced (14%), and adjuvant/neoadjuvant (5%) settings. Performance Status was zero (49%), one (41%) and ≥ 2 (10%). Median follow-up was 62.5 months, with median overall survival of 13.7 months and progression-free survival of 8.9 months. First-cycle dose reduction occurred in 14% of patients. Within the first month, 48% experienced toxicity leading to hospitalization and/or dose reduction, with 28% requiring a median 8-day hospitalization. Low muscle body mass (MBM) significantly correlated with dose reduction (AUC 0.63; p = 0.005). An NLR ratio less than 4 was significantly associated with longer OS (p = 0.001).

Low MBM is linked to FOLFIRINOX toxicity, suggesting MBM assessment could allow better selection of patients to avoid these toxicities, warranting further confirmation in larger cohorts.

Treatment decisions are challenging in older adults with solid tumors. Geriatric 8 (G8)-screening and comprehensive geriatric assessment (CGA) are important but additional methods are needed. We examined the association of computed tomography (CT)-derived high visceral adipose tissue index (VATI) with or without low skeletal muscle index (SMI) on three-month and overall survival (OS).

Vulnerability was evaluated with G8 in patients ≥75 years referred for systemic anticancer treatment. Vulnerable/frail patients (G8 ≤ 14) received CGA and were included. VATI and SMI were retrospectively measured from CT scans. We examined associations between high VATI with or without low SMI and three-month and OS with Cox regression models and Kaplan-Meier estimation.

Seventy-nine patients with median age of 80 (range 75-91) years were evaluated. In the palliative-intent group (n = 58), three-month OS rates were 88 % and 58 % in the normal and high VATI groups, respectively (hazard ratio 4.3; 95 % confidence interval 1.3-14), and 88 % vs. 47 % in group without and with 'high VATI+low SMI', respectively (5.5; 1.9-17). The median OS was 12.7 vs. 9.5 months in normal VATI/SMI and 'high VATI+low SMI' (1.9; 1.1-3.2), respectively. In Cox multivariable models with established predictive factors (ECOG PS, Clinical Frailty Scale, and sex), only high VATI (4.9; 1.0-24) or 'high VATI+low SMI' (8.9; 1.7-46) remained significant predictors of three-month OS.

High VATI with or without low SMI were associated with impaired three-month OS in the palliative-intent group and with OS in the whole cohort independently of oncologic and geriatric functional status measures; thus, they may aid in treatment decision-making.

To investigate baseline patient characteristics associated with the risk of computed tomography (CT)-based sarcopenia and assess whether sarcopenia and other morphometric parameters influence survival outcomes in patients with liver metastases and cholangiocarcinoma after Yttrium-90 radioembolization.

We retrospectively analyzed 120 cancer patients (mean age, 62 ± 13.3 years, 61 men) who underwent preprocedural CT. Skeletal muscle index (SMI) was measured at the L3 vertebral level to identify sarcopenia. The Cox proportional hazard model was performed to assess the prognostic value of the variables, and Kaplan-Meier analysis with log-rank text was used for overall survival (OS) assessment.

Sarcopenia was diagnosed in 70 patients (58.3%). The multivariate regression analysis demonstrated that male sex, body mass index (BMI), visceral fat radiation attenuation (VFRA), skeletal muscle radiation attenuation (SMRA), and subcutaneous fat radiation attenuation (SFRA) were associated with the incidence of sarcopenia with the odds ratio of 8.81 (95% CI, 2.09-37.1, p = 0.003), 0.64 (95% CI, 0.48-0.85, p = 0.002), 1.23 (95% CI, 1.06-1.42, p = 0.006), 0.79 (95% CI, 0.69-0.91, p = 0.001) and 0.84 (95% CI, 0.76-0.93, p = 0.001), respectively. Age, skeletal muscle index, and tumor subtypes were independent prognostic factors for OS with the hazard ratio of 1.03 (95% CI, 1.01-1.05, p = 0.01), 0.92 (95% CI, 0.86-0.99, p = 0.021) and 2.09 (95% CI, 1.31-3.33 p = 0.002), respectively. In patients with intrahepatic cholangiocarcinoma, median OS was significantly longer in the non-sarcopenic group than in the sarcopenic patient (25.9 versus 6.5 months, p = 0.029).

Male sex, BMI, VFRA, SMRA, and SFRA were associated with the incidence of sarcopenia. SMI value could be used as a biomarker for OS in patients treated with Yttrium-90 radioembolization.

Question The prognostic significance of CT-based sarcopenia and other morphometric parameters in patients with liver metastases and cholangiocarcinoma undergoing Yttrium-90 radioembolization remains unclear. Findings A high skeletal muscle index has been identified as an independent protective factor for overall survival in cancer patients treated with Yttrium-90 radioembolization. Clinical relevance The negative impact of CT-based sarcopenia has been confirmed in the context of Yttrium-90 radioembolization. Clinicians should strive to prevent the progression of sarcopenia or maintain skeletal muscle index in perioperative management.

Background: A strong body of evidence exists demonstrating deleterious relationships between abnormal body composition (BC) and outcomes in non-complex colorectal cancer. Complex rectal cancer (RC) includes locally advanced and locally recurrent tumours. This scoping review aims to summarise the current evidence examining BC in complex RC. Methods: A literature search was performed on Ovid MEDLINE, EMBASE, and Cochrane databases. Original studies examining BC in adult patients with complex RC were included. Two authors undertook screening and full-text reviews. Results: Thirty-five studies were included. Muscle quantity was the most commonly studied BC metric, with sarcopenia appearing to predict mortality, recurrence, neoadjuvant therapy outcomes, and postoperative complications. In particular, 10 studies examined relationships between BC and neoadjuvant therapy response, with six showing a significant association with sarcopenia. Only one study examined interventions for improving BC in patients with complex RC, and only one study specifically examined patients undergoing pelvic exenteration. Marked variation was also observed in terms of how BC was quantified, both in terms of anatomical location and how cut-off values were defined. Conclusions: Sarcopenia appears to predict mortality and recurrence in complex RC. An opportunity exists for a meta-analysis examining poorer BC and neoadjuvant therapy outcomes. There is a paucity of studies examining interventions for poor BC. Further research examining BC specifically in patients undergoing pelvic exenteration surgery is also lacking. Pitfalls identified include variances in how BC is measured on computed tomography and whether external cut-off values for muscle and adipose tissue are appropriate for a particular study population.

Malnutrition is a significant concern in children with β-thalassemia, impacting their growth and overall health. This study aimed to establish optimal thresholds for predicting malnutrition risk in children with β-thalassemia using muscle mass indicators derived from Bioelectrical Impedance Analysis (BIA).

A cross-sectional study was conducted with 162 pediatric patients diagnosed with β-thalassemia. Nutritional status of them was assessed using the World Health Organization (WHO) Child Growth Standards and references. BIA was performed to obtain fat-free mass (FFM), skeletal muscle mass (SMM), and soft lean mass (SLM). Propensity score matching (PSM) was used to control for age and gender. Receiver Operating Characteristic (ROC) curves were constructed to evaluate the diagnostic performance.

SLM-change < 6% demonstrated the highest sensitivity [0.82, 95% confidence interval (CI) 0.72-0.92] and a negative predictive value of 0.83 (95% CI 0.74-0.93), while FFM-change < 4% showed more balanced performance with a sensitivity of 0.58 (95% CI 0.45-0.71) and a specificity of 0.65 (95% CI 0.56-0.74). Percentage change indicators (FFM-change, SLM-change, and SMM-change) exhibited remarkable stability before and after PSM, indicating minimal influence from age and gender.

This study established novel, age-adaptive thresholds (SLM-change < 6% and FFM-change < 4%) for predicting malnutrition risk in children with β-thalassemia. The findings suggest that these thresholds could serve as effective references to assess nutritional status across different age groups, providing new perspectives for personalized nutritional management strategies.

Women with breast cancer are predisposed to muscle mass loss, to compromised muscle quality, and to decreased strength, and these abnormalities may serve as important predictors of adverse outcomes, including mortality. The aim of this study was to evaluate the possible associations between muscle mass markers, assessed by computed tomography with the phase angle (PhA) obtained by Bioelectrical impedance analysis (BIA), and health outcomes in women with breast cancer.

retrospective study with 54 women newly diagnosed with breast cancer, aged ≥ 18 years and < 65 years; histologically confirmed diagnosis of early breast cancer (stage I-III range), and in the first chemotherapy-cycled treatment. Measurements performed: anthropometric assessments, BIA, third lumbar vertebra by computed tomography (CT) and physical function (handgrip strength, gait speed test 4 m, fatigue assessment), and blood biochemical analysis.

Lower skeletal muscle index were correlated with reduced PhA values (R² = 0.222, p = 0.0047), suggesting a worse prognosis. Logistic regression analysis showed that individuals with low muscle mass had a significantly lower likelihood of survival compared to those with normal muscle mass regardless of age and cancer stage.

low muscle mass negatively affected patient survival and was associated with lower PhA values. Phase angle emerges as a promising marker of overall health and could be a valuable clinical tool in assessing prognosis.

Previous research has demonstrated notable differences in body composition and mortality risk following hip fracture between sexes. This study aimed to investigate the sex-specific associations between body composition profile and mortality in older patients undergoing hip fracture surgery.

Dual-center cohort study.

We included 488 older patients (aged ≥60 years) with hip fracture treated with surgery.

The cross-sectional area and attenuation of skeletal muscle, subcutaneous adipose tissue, and intermuscular adipose tissue at the the upper thigh level on preoperative pelvic computed tomography (CT) were measured. The relationship between body composition and mortality was determined using Cox proportional hazards analysis stratified by sex.

The mean age of the cohort was 76.2 ± 8.7 years, and 312 (63.9%) were women. Within 1 year after surgery, 89 (18.2%) patients died. Female patients had greater subcutaneous adipose tissue area [SATA; median (interquartile range), 196.5 (160.1∼228.5) vs 147.1 (111.3∼181.1) cm2; P < .001] and lower skeletal muscle area [SMA; 187.2 (167.3∼212.4) vs 255.5 (223.2∼286.1) cm2; P < .001] compared with male patients. In the sex-stratified multivariable analyses, SATA in females [hazard ratio (HR), 0.92; 95% confidence interval (CI), 0.86∼0.97; P = .003] and SMA in men (HR, 0.93; 95% CI, 0.86∼1.00; P = .05) were significant predictors of 1-year mortality. Incorporation of SATA or SMA within the existing Nottingham Hip Fracture Score (NHFS) showed slightly improved performance in predicting 1-year mortality among women [area under the curve (AUC), 0.70 vs 0.64, P = .11] or men (AUC, 0.76 vs 0.71, P = .06), respectively.

Reduced subcutaneous adiposity is associated with mortality in older women undergoing hip fracture surgery, while reduced muscle mass predicts mortality in men. These findings highlight the importance of considering sexual dimorphism in the development of novel biomarkers and effective treatment strategies.

Postoperative changes in body composition (BC) have not been clearly defined. The aim of this study was to clarify the impact of postoperative comprehensive changes in BC on long-term prognosis in gastric cancer (GC) patients.

A total of 366 GC patients who underwent radical gastrectomy were included. Postoperative changes in skeletal muscle volume, body fat volume, and skeletal muscle density were investigated at six months postoperatively using computed tomography and evaluated their association with long-term survival.

Patients with decreased muscle volume, decreased fat volume, and increased muscle density had a poor prognosis, respectively. When the risk scores based on these three BC parameters were applied, patients were classified from score 0 to 4, with survival rate declining as the scores improved: score 0, interim 5-year overall survival 94%; score 1, 82%; score 2, 73%; score 3, 56%; and score 4, 20%. BC change (score > 2) was an independent poor prognosticator (HR, 3.086; p < 0.001). Preoperative myosteatosis, high Charlson comorbidity, and total gastrectomy were identified as significant independent risk factors for BC change.

Each of postoperative skeletal muscle loss, body fat loss, and muscle hyperdensity negatively affected prognosis of GC patients after surgery, and the BC risk scoring assessment well predicted the prognosis of postoperative patients with GC.

Sarcopenia is a common indicator of systemic nutritional status in patients with cancer progression. This study investigated the impacts of sarcopenia on adverse effects and prognosis of sarcopenia on patients with esophageal cancer receiving chemoradiotherapy.

The clinical data of 158 patients with initially diagnosed esophageal cancer who received chemoradiotherapy were collected, and nutritional indexes and inflammatory markers were calculated. The cross-sectional areas of the skeletal muscle, subcutaneous fat and visceral fat were calculated using computed tomography (CT) images of the midpoint of the third lumbar (L3) vertebra. The incidence of adverse events, response evaluation, 1-year and 3-year overall survival (OS) and progression-free survival (PFS) were compared between sarcopenia group and non-sarcopenia groups.

This study included 158 patients, 103 (71.5%) in the sarcopenia group and 45 (28.5%) in the non-sarcopenia group. The last follow-up date was January 31, 2024. The median follow-up time was 36 months for all patients. The chi-square test revealed no significant difference in the incidence of serious adverse events between the two groups. The complete response rates (CR) of patients in the sarcopenia and non-sarcopenia groups 1 month after chemoradiotherapy were 2.7 and 13.3%, respectively, p = 0.017, and the difference was statistically significant. Moreover, the objective response rates (ORR) were 38.9 and 60.0%, respectively (χ2 = 5.770, p = 0.016). The median survival time for all patients was 36 months [95% Confidence Interval CI 24-48]. Univariate analysis (Cox proportional risk model) showed that sarcopenia, KPS score, albumin level, T stage, and N stage were correlated with patients' OS. Multivariate analysis showed that sarcopenia (Hazard Ratio HR 2.84, 95%CI [1.45-5.57], p = 0.002), KPS score, albumin level and N stage were independent prognostic factors for OS.

Sarcopenia reduced OS in patients with EC treated with chemoradiotherapy. It can be used as an independent indicator to predict the OS of such patients, which may help in developing optimal treatment strategies.

Sarcopenia, characterized by age-related loss of muscle mass and function, significantly impacts the quality of life of older adults. This condition is prevalent among elderly patients with hip fractures.

To investigate the association of sarcopenia and sarcopenic obesity with mortality and length of hospital stay in patients admitted for hip fracture. Additionally, this study aims to investigate possible risk factors associated with higher mortality rates in the same patient groups.

A retrospective cohort study was conducted involving patients aged 60 and older who underwent hip fracture surgery between February 2019 and April 2023 at a single tertiary care hospital. Sarcopenia was defined using appendicular skeletal muscle mass index (ASMI) and psoas muscle index values derived from preoperative computed tomography scans. Patients were categorized into sarcopenic, sarcopenic obese, and non-sarcopenic groups. Primary outcomes included 1-year mortality, and secondary outcomes included hospital stay duration. Cox regression and binary logistic regression analyses were performed, adjusting for potential confounders including age, sex, and comorbidities.

The study included 311 patients (mean age 79.7 years). After adjustment for confounders, sarcopenia, as defined by ASMI, was associated with a higher 1-year mortality risk (hazard ratio [HR]: 1.80, 95% confidence interval [CI]: 1.04-3.13, p = .034). Sarcopenic obesity further increased mortality risk (HR: 2.68, 95% CI: 1.10-2.57, p = .016). Sarcopenia alone was not significantly associated with prolonged hospital stays after adjustment.

Sarcopenia remained independently associated with mortality in patients with hip fractures after adjustment for various factors. Sarcopenic obesity was associated with a higher risk of mortality than sarcopenia alone. These findings underscore the prognostic significance of sarcopenia in this vulnerable population.

Background: Sarcopenia has been associated with poor outcomes in pancreatic cancer (PC). However, published results are heterogeneous in terms of study design, oncological outcomes, and sarcopenia measurements. This meta-analysis aims to evaluate the impact of computed tomography (CT)-based sarcopenia on overall survival (OS) and progression-free survival (PFS) in patients with PC, considering potential confounders such as the CT-based method and thresholds used to define sarcopenia, as well as treatment intention. Methods: We systematically searched databases for observational studies reporting hazard ratios (HRs) for OS and PFS in PC patients stratified by CT-based sarcopenia status. Random-effects models were used to calculate pooled crude and adjusted HRs (cHRs and aHRs, respectively), with subgroup analyses based on sarcopenia measurement methods, cutoff values, sarcopenia prevalence, and treatment intention. Heterogeneity was assessed using the I2 and τ2 statistics, and publication bias was evaluated using funnel plots and Egger's test. Results: Data from 48 studies were included. Sarcopenia was significantly associated with worse OS (pooled cHR = 1.58, 95% CI: 1.38-1.82; pooled aHR = 1.39, 95% CI: 1.16-1.66) and worse PFS (pooled cHR = 1.55, 95% CI: 1.29-1.86; pooled aHR = 1.31, 95% CI: 1.11-1.55). Subgroup analyses revealed significantly different, stronger associations in studies using stricter sarcopenia cutoffs (<50 cm2/m2 for males) and in patients undergoing curative treatments. Heterogeneity was substantial across analyses (I2 > 67%), but with generally low τ2 values (0.01-0.25). Egger's test indicated potential publication bias for OS (p < 0.001), but no significant bias was observed for PFS (p = 0.576). Conclusions: Sarcopenia determined by CT is an independent predictor of poor OS and PFS in PC, but this association varies depending on the cutoff used for its definition as well as on the treatment intention. Therefore, its routine assessment in clinical practice could provide valuable prognostic information, but future research should focus on standardizing sarcopenia assessment methods.

To investigate the impact of sarcopenia assessed by pretherapy magnetic resonance imaging (MRI) of the third cervical vertebra (C3) on the survival of patients with locally advanced nasopharyngeal carcinoma (LANPC).

We analyzed the clinical information of 478 patients with LANPC who underwent radiotherapy between July 2016 and June 2019. Sarcopenia was evaluated using the skeletal muscle mass index, which was determined based on an MRI of the C3. The cutoff values for sarcopenia were determined using receiver operating characteristic curves. The thresholds were < 12.83 cm2/m2 for male and < 11.15 cm2/m2 for female. Comparisons between patients with and without sarcopenia were conducted using the chi-squared test. The Kaplan-Meier method was applied to plot survival curves, which were then assessed using the log-rank test. Survival factors were identified using univariate and multivariate analyses.

The 5-year overall survival (OS) rate was 75.3%, with a median follow-up period of 59 months. Patients with sarcopenia (181/478) had a lower OS than those without sarcopenia (70.7% vs 78.1%, hazard ratio = 1.87, 95% confidence interval: 1.26-2.77, P < 0.01). Sarcopenia was elevated in patients with advanced T-stage tumors and a low body mass index. Univariate and multivariate analyses showed that sarcopenia, age, sex, T stage, and N stage were significant variables that affected the OS of patients with LANPC (P < 0.05).

MRI-based sarcopenia is significantly correlated with the OS of patients with LANPC. This finding highlights the importance of evaluating sarcopenia before treatment, as it can guide personalized treatment programs, thereby enhancing patient prognosis.

Optimal timing for surgery after neoadjuvant chemoradiotherapy (NCRT) remains controversial, necessitating reliable preoperative indicators. This study examines how sarcopenia and surgical timing affect prognosis in patients with locally advanced esophageal squamous cell carcinoma (LA-ESCC).

This retrospective study analyzed patients with LA-ESCC who underwent NCRT and surgery at three institutions in China from 2014 to 2023. The skeletal muscle area at the third lumbar vertebra was measured to calculate the skeletal muscle index (SMI). Prognostic analysis was performed using Cox proportional hazards models and propensity score matching (PSM), with survival curves generated using the Kaplan-Meier method and statistical significance set at p<0.05.

A total of 415 patients were analyzed, with a median follow-up of 39.1 months. The 5-year overall survival (OS) and progression-free survival (PFS) rates were 59.3% and 53.1%, respectively. Malnutrition and time to surgery (TTS) were independent prognostic factors for both OS and PFS (p < 0.05). Patients with long TTS showed better OS [hazard ratio (HR) = 0.62, p = 0.01] and PFS (HR = 0.68, p = 0.02) compared with those with short TTS. Among patients with sarcopenia, long TTS significantly improved OS (HR = 0.56; p = 0.01) and PFS (HR = 0.62; p = 0.02), while no survival benefit was observed for TTS in patients who were nonsarcopenic (p > 0.05).

Sarcopenia does not independently impact OS or PFS. Patients with sarcopenia benefit from a longer surgical time interval after NCRT. In addition, preoperative evaluation of muscle quality may aid in optimizing surgical timing to improve outcomes.

The aim of our study is to evaluate the relationship between sarcopenia, overall survival (OS), and chemotherapy toxicity in patients with unresectable/metastatic soft tissue sarcoma (STS) treated with adriamycin and ifosfamide.

Patients with unresectable/metastatic STS over the age of 18, diagnosed between 2015 and 2023, were included in the study. The study was conducted retrospectively in a single center. Total muscle volume at the lumbar 3 (L3) vertebra level was measured from the patient's computer tomography (CT) images. The skeletal muscle index (SMI) was calculated for each patient. Additionally, the prognostic nutritional index (PNI) was calculated for each patient using blood values.

Fifty-eight patients were included in the study. The median age of the patients was 51 years, Thirty-six (62.1%) were female and 22 (37.9%) were male. The SMI median was 49 cm2/m2 in male patients. ROC analysis demonstrated a statistically significant prediction of OS when the SMI index was < 49.2 cm2/m2. In female patients, the median SMI was 40 cm2/m2. ROC analysis demonstrated a statistically significant prediction of OS when the SMI index was < 40.3 cm2/m2. Median OS in the SMI < 49 cm2/m2 male group was 9 months (95% CI 7.99-10.08). In the SMI ≥ 49 cm2/m2 male group, the median OS was 30.2 months (95% CI 0.0-66.66). OS was statistically significant between the two groups (p = 0.003). The median OS in the SMI < 40 cm2/m2 female group was 20.5 months (95% CI 7.69-33.30). In the SMI ≥ 40 cm2/m2 female group, the median OS was 59.1 months (95% CI 21.36-96.98). OS was statistically significant between the two groups (p = 0.025). The relationship of SMI, as well as PNI, age, and Eastern Cooperative Oncology Group performance status (ECOG PS) with OS, was assessed. The relationship between SMI and chemotherapy toxicity was also evaluated. Chemotherapy-related toxicity was found to be significantly higher in sarcopenic patients (male SMI < 49 cm2/m2, female SMI < 40 cm2/m2) (p = 0.025).

A significant relationship was found between SMI and OS, but no significant relationship was found between PNI and OS. A significant relationship was also detected between SMI and treatment toxicity. Our study reveals that evaluating ECOG PS and sarcopenia in addition to grade and histological subtype when making treatment decisions will be associated with longer survival and less toxicity.

Sarcopenia is common in chronic pancreatitis (CP) and has been associated with unfavorable outcomes; however, it is not well studied in acute pancreatitis (AP).

To evaluate risk factors for sarcopenia among individuals with AP or CP.

A cross sectional analysis was performed among subjects with AP or CP seen in a tertiary care Pancreas Clinic. TeraRecon software was used to calculate the cross-sectional area of skeletal muscle, visceral fat, and subcutaneous fat at the level of the L3 vertebrae. Sarcopenia was classified using sex-specific skeletal muscle index. Univariate and multivariate logistic regressions were performed to assess differences between groups and associations with sarcopenia.

A total of 49 subjects with AP and 54 subjects with CP were included. Sarcopenia was more frequently observed in CP compared to AP (83.3% vs. 46.9%, p < 0.001). The multivariate logistic regression demonstrated CP, male sex, increased age, and decreased subcutaneous fat were independently associated with sarcopenia.

Sarcopenia is observed in both CP and AP. In addition to traditional risk factors (including male sex, older age, and decreased subcutaneous fat), CP is independently associated with sarcopenia. Further investigations are necessary to gain deeper insights into sarcopenia pathogenesis, which could inform potential intervention strategies.

This study investigates the association between baseline CT body composition parameters and clinical outcomes in patients with resectable non-small cell lung cancer (NSCLC).

Patients who underwent surgical resection for NSCLC between January 2006 and December 2017 were retrospectively enrolled in this multicenter study. Body composition metrics, including the area of skeletal muscle, intermuscular adipose tissue, subcutaneous adipose tissue, visceral adipose tissue, muscle radiodensity, and derivative parameters from five basic metrics mentioned before, were calculated based on preoperative non-contrast-enhanced chest CT images at L1 level. The Cox proportional hazards regression analysis was used to evaluate the association between body composition metrics and survival outcomes including overall survival (OS) and disease-free survival (DFS).

A total of 2712 patients (mean age, 61.53 years; 1146 females) were evaluated. A total of 635 patients (23.41%) died. 465 patients (19.51%) experienced recurrence and/or distant metastasis. After multivariable adjustment, skeletal muscle index (SMI, HR = 0.86), intermuscular adipose index (IMAI, HR = 1.49), and subcutaneous adipose index (SAI, HR = 0.96) were associated with OS. Similar results were found after stratification by gender, TNM stage, and center. There was no significant association between all body composition metrics and DFS (all p > 0.05). The body composition metrics significantly enhance the model including clinicopathological factors, resulting in an improved AUC for predicting 1-year and 3-year OS, with AUC values of 0.707 and 0.733, respectively.

SMI, IMAI, and SAI body composition metrics have been identified as independent prognostic factors and may indicate mortality risk for resectable NSCLC patients.

Our findings emphasize the significance of muscle mass, quality, and fat energy storage in clinical decision-making for patients with non-small cell lung cancer (NSCLC). Nutritional and exercise interventions targeting muscle quality and energy storage could be considered for patients with NSCLC.

Multiparameter body composition analysis is associated with the clinical outcome in NSCLC patients. Assessing muscle mass, quality, and adipose tissue helps predict overall survival in NSCLC. The quantity and distribution of body composition can contribute to unraveling the adiposity paradox.

This study efforts to explore the association between sarcopenia, an age-related decline in muscle mass and physical function, and clinical outcomes in women with triple-negative breast cancer (TNBC).

This retrospective study included women diagnosed with TNBC who received breast surgery from December 2012 to December 2018. Skeletal muscle mass index (SMI) is utilized to evaluate sarcopenia, which was quantified by the cross-sectional area of muscle at the twelfth thoracic vertebra (T12). Disease-free survival (DFS) and overall survival (OS) are the endpoints. The association of sarcopenia with DFS and OS was statistically analyzed.

The study included 130 women in all, with a median age of 55 years (median follow-up, 53 months). Among them, 78 (58.5%) women had sarcopenia (SMI <28.01). 38 patients (29.2%) died and 49 patients (37.7%) experienced a recurrence of breast cancer throughout the follow-up period. Sarcopenia was demonstrated to be a significant predictive factor for both OS (HR,2.885; 95% CI, 1.349-6.169; p = 0.006) and DFS (HR,3.121; 95% CI, 1.578-6.175; p = 0.001) in the multivariate Cox proportional hazard model. There was no significant correlation seen between body mass index and either DFS (p = 0.156) or OS (P = 0.264). Logistic regression model further revealed that sarcopenia was a prognostic factor that was independently associated with both DFS (p = 0.001) and OS (p = 0.006).

Among women with TNBC, sarcopenia is associated with worse clinical outcomes. These patients with high risk might be candidates for individual programmed exercise and diet interventions to optimize survival outcomes.

Low skeletal muscle mass and impaired muscle quality (myosteatosis) have been associated with poor outcomes in cancer patients. This study aimed to evaluate the impact of pre-therapeutic low muscle mass and myosteatosis on chemoradiotherapy (CRT)-induced toxicity and survival outcomes in patients with non-resectable pancreatic cancer (PC).

In this retrospective study, pre-therapeutic CT scans were used to measure muscle mass/density. Low muscle mass was defined as a skeletal muscle index <38.5 cm²/m² (women) and <52.4 cm²/m² (men), and myosteatosis as a mean psoas density <41 HU if BMI < 25 kg/m² or <33 HU if BMI > 25 kg/m². Adverse effects were collected per week (W) of treatment. Dose-limiting toxicity (DLT) was defined as any toxicity leading to dose reduction, treatment delays or permanent discontinuation.

Among the 85 included patients, 75 (88.2%) and 18 (22.2%) had pre-therapeutic low muscle mass and myosteatosis, respectively. Only 12 patients (14.1%) experienced DLT. Patients with low muscle mass developed significantly more toxicities at W2 (p = 0.013) and W5 (p = 0.026), notably more nausea (p = 0.037) and anemia (p = 0.004). Low muscle mass was associated with poorer overall survival (HR 4.41 [1.50-12.94], p = 0.007) in multivariate Cox analysis, while myosteatosis was not associated with CRT toxicities, DLT and overall survival (p = 0.408).

Patients with low muscle mass experienced more toxicities and poorer outcomes during CRT for non-resectable PC.

Background/Objectives: Sarcopenia is an emergent prognostic biomarker in clinical oncology. Albeit increasingly defined through skeletal muscle index (SMI) thresholding, the literature cut-offs fail to discern heterogeneous baseline muscularity across populations. This study assesses the prognostic impact of using cohort-specific SMI thresholds in a Portuguese metastatic non-small-cell lung cancer (mNSCLC) cohort. Methods: Retrospective study including mNSCLC patients treated between January 2017 and December 2022. ImageJ v1.54 g was used to assess cross-sectional CT imaging at the third lumbar vertebra (L3) and calculate L3SMI. Sarcopenia was defined both according to Prado et al. and L3SMI thresholds derived from receiver operating characteristic analysis. Overall survival (OS) was the primary endpoint. Secondary endpoints included first-line (1L) progression-free survival (PFS) and sarcopenia subgroup analysis regarding body mass index impact on OS. Results: The initial cohort included 197 patients. Mean age was 65 years (±11.31). Most tumors were adenocarcinomas (n = 165) and presented with metastasis (n = 154). SMI was evaluable in 184 patients: cohort-specific thresholds (<49.96 cm2/m2 for men; <34.02 cm2/m2 for women) yielded 46.74% sarcopenic patients (n = 86) versus 66.30% (n = 122) per the literature definition. Cohort-specific thresholds predicted both OS (12.75 versus 21.13 months, hazard ratio [HR] 1.654, p = 0.002) and PFS (7.92 versus 9.56 months, HR 1.503, p = 0.01). Among sarcopenic patients, overweight (HR 0.417, p = 0.01) and obesity (HR 2.723, p = 0.039) had contrasting impacts on OS. Conclusions: Amid reclassification of nearly one-fifth of the cohort, cohort-specific thresholds improved sarcopenia prognostication in mNSCLC. Homogeneity regarding both cancer treatment setting and ethnicity could be key to defining sarcopenia based on SMI.

Patients with advanced-stage pancreatic ductal adenocarcinoma (PDAC) are regularly treated with FOLFIRINOX, a chemotherapy regimen based on 5-fluorouracil, irinotecan and oxaliplatin, which is associated with high toxicity. Dosing of FOLFIRINOX is based on body surface area, risking under- or overdosing caused by altered pharmacokinetics due to interindividual differences in body composition. This study aimed to investigate the relationship between body composition and treatment toxicity in advanced stage PDAC patients treated with FOLFIRINOX.

Data from patients treated at the Maastricht University Medical Centre + between 2012 and 2020 were collected retrospectively (n = 65). Skeletal muscle-, visceral adipose tissue, subcutaneous adipose tissue-, (SM-Index, VAT-Index, SAT-Index resp.) and Skeletal Muscle Radiation Attenuation (SM-RA) were calculated after segmentation of computed tomography (CT) images at the third lumbar level using a validated deep learning method. Lean body mass (LBM) was estimated using SM-Index. Toxicities were scored and grade 3-4 adverse events were considered dose-limiting toxicities (DLTs).

Sixty-seven DLTs were reported during the median follow-up of 51.4 (95%CI 39.2-63.7) weeks. Patients who experienced at least one DLT had significantly higher dose intensity per LBM for all separate cytotoxics of FOLFIRINOX. Independent prognostic factors for the number of DLTs per cycle were: sarcopenia (β = 0.292; 95%CI 0.013 to 0.065; p = 0.013), SM-Index change (% per 30 days, β = -0.045; 95%CI -0.079 to -0.011; p = 0.011), VAT-Index change (% per 30 days, β = -0.006; 95%CI -0.012 to 0.000; p = 0.040) between diagnosis and the first follow-up CT scan, and cumulative relative dose intensity >80 % (β = -0.315; 95 % CI -0.543 to -0.087; p = 0.008).

Sarcopenia and early muscle and fat wasting during FOLFIRINOX treatment were associated with treatment-related toxicity, warranting exploration of body composition guided personalized dosing of chemotherapeutics to limit DLTs.

Chest computed tomography (CT) is a valuable tool for diagnosing and predicting the severity of coronavirus disease 2019 (COVID-19) and assessing extrapulmonary organs. Reduced muscle mass and visceral fat accumulation are important features of a body composition phenotype in which obesity and muscle loss coexist, but their relationship with COVID-19 outcomes remains unclear. In this study, we aimed to investigate the association between the erector spinae muscle (ESM) to epicardial adipose tissue (EAT) ratio (ESM/EAT) on chest CT and disease severity in patients with COVID-19.

We analysed data from 1074 COVID-19 patients enrolled in the Japan COVID-19 Task Force database. The primary outcome was the rate of critical outcomes (requiring high-flow oxygen therapy, invasive ventilator support or death). The incidence of critical outcomes was compared between patients with high and low ESM/EAT ratios.

The low ESM/EAT group (n = 353) had a higher incidence of critical outcomes (13.3% vs. 5.13%, p < 0.001) and mortality (2.55% vs. 0.69%, p = 0.019) than the high ESM/EAT group (n = 721). In multivariable analysis, the low ESM/EAT ratio was associated with critical outcomes (adjusted odds ratio [aOR] 2.11, 95% confidence interval [CI] 1.22-3.66) independently of the known COVID-19 severity factors including age, sex, body mass index (BMI), smoking history, lifestyle-related comorbidities and pneumonia volume.

The low ESM/EAT ratio in COVID-19 patients can be obtained on chest CT and used to predict critical outcomes after disease onset, demonstrating the importance of detailed body composition assessments in COVID-19 practice.