Prognostic role of sarcopenia in metastatic colorectal cancer patients during first-line chemotherapy: A retrospective study

BACKGROUNDSarcopenia is a condition characterized by decreased skeletal muscle mass due to physiological ageing or to a concomitant disease such as neoplasia. In cancer patients, a low lean body mass is suggested to be a negative prognostic factor for survival and for the development of dose-limiting chemotherapy toxicities irrespective of disease stage. AIMTo evaluate the prognostic role of sarcopenia in patients with metastatic colorectal cancer (mCRC) undergoing first-line chemotherapy.METHODSOur retrospective analysis included 56 mCRC patients who received first-line chemotherapy from 2014 to 2017 at the Medical Oncology Unit of our hospital. Computerized scans were performed before starting chemotherapy and at the first disease reassessment. Sarcopenia was assessed using the skeletal mass index = muscle area in cm²/(height in m²) calculated at the L3 vertebra. Overall survival and objective response rate were evaluated. Toxicities were analyzed during the first four cycles of therapy and graded according to Common Terminology Criteria for Adverse Events version 4.0. A loss of skeletal muscle mass ≥ 5% was considered indicative of deterioration in muscle condition.RESULTSMedian age was 67 years and 35.7% of patients were ≥ 70 years old. Fourteen patients (25%) were sarcopenic at baseline computed tomography (CT) scan (7/33 men; 7/23 women); 5/14 sarcopenic patients were ≥ 70 years old. Median follow-up was 26.8 mo (3.8-66.8 mo) and median overall survival was 27.2 mo (95%CI: 23.3-37.3). Sarcopenia was not correlated to overall survival (P = 0.362), to higher toxicities reported during the first 4 cycles of chemotherapy (P = 1.0) or to response to treatment (P = 0.221). At the first disease reassessment, a skeletal muscle loss (SML) ≥ 5% was found in 17 patients (30.3%) 3 of whom were already sarcopenic at baseline CT scan, while 7 patients became sarcopenic. SML was not correlated to overall survival (P = 0.961). No statistically significant correlation was found between baseline sarcopenia and age (P = 1.0), body mass index (P = 0.728), stage at diagnosis (P = 0.355) or neutrophil/lymphocyte ratio (P = 0.751).CONCLUSIONNeither baseline sarcopenia nor SML affected survival. In addition, baseline sarcopenia was not related to worse treatment toxicity. However, these results must be interpreted with caution due to the limited sample size.     

肌少症对食管鳞癌术后复发患者放化疗不良反应及预后影响

目的 探讨基于定位CT分析肌少症对食管鳞癌术后复发患者放化疗期间不良反应及预后的影响。方法 回顾性分析2016—2017年于淮安市第一人民医院行放化疗的147例食管鳞癌术后局部复发患者,依据模拟定位CT勾画计算主动脉弓上缘水平横断面双侧胸肌面积（PMA）。PMA身高校正（PMA/身高²）得出胸肌指数（PMI）。将男女患者分别依据PMI三分位数分组,其中低PMI者（男性<11.55 cm²/m²,女性<8.69 cm²/m²）为肌少症组。比较肌少症组与非肌少症组患者治疗期间不良反应发生率及1年和3年总生存（OS）率的差异。结果 147例患者中49例（33.3%）存在肌肉减少,该类患者3‐4级不良反应发生率显著高于非肌少症患者（40.8%∶18.4%,P=0.005）。肌少症患者1年和3年OS（61.2%和10.2%）显著低于非肌少症患者（82.7%和28.6%）,差异具有统计学意义（P<0.001）,多因素分析证实肌少症是预测不良预后的独立危险因素（P<0.001）。结论 基于定位CT获得的PMI在诊断肌少症方面具有较好的临床价值,可能可以作为诊断肌少症的新工具。     

Is handgrip strength a marker of muscle and physical function of the lower limbs? Sex differences in older adults with obesity

Background and aimsIn this cross-sectional study we investigate the association between handgrip strength (HGS) and muscle function of the lower limbs and the predictors of the appendicular lean mass index (ALMI) in older adults with obesity of both sexes.Methods and resultsEighty-four older (67 ± 5 years) men (N = 44) and women (N = 40) with obesity (body mass index (BMI) 33 ± 4 kg/m²) performed: the HGS, isokinetic knee extensors (KE) and flexors (KF) muscle strength and power and Short Physical Performance Battery (SPPB). The correlation between HGS and lower limbs muscle function was evaluated, and four multiple hierarchical linear models were built to assess the contribution of each ALMI predictor (i.e., HGS, BMI, SPPB, muscle strength and power).In men, HGS was weakly-to-moderately associated (p < 0.05) with KE, KF muscle function and physical performance. In women, HGS showed a weak association (p < 0.05) with KE muscle function. The significant predictors of ALMI were only the BMI in women, whereas in the group of men BMI, KE maximal strength and power better explain the variance in ALMI than HGS alone.ConclusionOur results suggest that HGS should not be used alone as a marker of lower muscle nor physical function. Sex differences exist with the BMI that is a contributor of ALMI both in men and women. However, at least in the group of men, markers related to strength and power of the lower limbs can better describe variations in ALMI compared to HGS in this kind of population.Clinical trial registrationNA.     

Older men are more fatigable than young when matched for maximal power and knee extension angular velocity is unconstrained

The underlying factors related to the divergent findings of age-related fatigue for dynamic tasks are not well understood. The purpose here was to investigate age-related fatigability and recovery between a repeated constrained (isokinetic) and an unconstrained velocity (isotonic) task, in which participants performed fatiguing contractions at the velocity (isokinetic) or resistance (isotonic) corresponding with maximal power. To compare between tasks, isotonic torque–power relationships were constructed prior to and following both fatiguing tasks and during short-term recovery. Contractile properties were recorded from 9 old (~75 years) and 11 young (~25 years) men during three testing sessions. In the first session, maximal power was assessed, and sessions 2 and 3 involved an isokinetic or an isotonic concentric fatigue task performed until maximal power was reduced by 40 %. Compared with young, the older men performed the same number of contractions to task failure for the isokinetic task (~45 contractions), but 20 % fewer for the isotonic task (p < 0.05). Regardless of age and task, maximal voluntary isometric contraction strength, angular velocity, and power were reduced by ~30, ~13, and ~25 %, respectively, immediately following task failure, and only isometric torque was not recovered fully by 10 min. In conclusion, older men are more fatigable than the young when performing a repetitive maximal dynamic task at a relative resistance (isotonic) but not an absolute velocity (isokinetic), corresponding to maximal power.     

Serum albumin and muscle measures in a cohort of healthy young and old participants

Consensus on clinically valid diagnostic criteria for sarcopenia requires a systematical assessment of the association of its candidate measures of muscle mass, muscle strength, and physical performance on one side and muscle-related clinical parameters on the other side. In this study, we systematically assessed associations between serum albumin as a muscle-related parameter and muscle measures in 172 healthy young (aged 18–30 years) and 271 old participants (aged 69–81 year) from the European MYOAGE study. Muscle measures included relative muscle mass, i.e., total- and appendicular lean mass (ALM) percentage, absolute muscle mass, i.e., ALM/height² and total lean mass in kilograms, handgrip strength, and walking speed. Muscle measures were standardized and analyzed in multivariate linear regression models, stratified by age. Adjustment models included age, body composition, C-reactive protein and lifestyle factors. In young participants, serum albumin was positively associated with lean mass percentage (p = 0.007) and with ALM percentage (p = 0.001). In old participants, serum albumin was not associated with any of the muscle measures. In conclusion, the association between serum albumin and muscle measures was only found in healthy young participants and the strongest for measures of relative muscle mass.     

肌肉减少症的诊断及治疗

肌肉减少症是以骨骼肌质量减少及其功能减退为主要特点的一个复杂的综合征,已有研究证实,肌肉减少症除了发生在老年人外,还与营养不良及很多临床疾病相关。目前对肌肉减少症的研究还处于初期探索阶段,其发病原因及诊疗仍不十分清楚,本文将就目前肌肉减少症的研究进展作一综述。     

老年肌少症患者营养管理的最佳证据总结

目的 提取、评价和综合老年肌少症患者营养管理的相关证据,为制订科学、有效的老年肌少症患者营养管理方案提供循证依据。方法 计算机检索乔安娜布里格斯研究所循证卫生保健中心数据库、Cochrane Library、DynaMed循证医学临床决策网站、英国卫生与临床优化研究所指南网、国际实践指南图书馆、加拿大安大略注册护士协会指南网、WHO指南网、苏格兰校际间指南网、美国临床实践指南网、加拿大临床实践指南信息库、UpToDate临床决策、中国医脉通临床指南网、Web of Science、PubMed、中国知网、中华医学会期刊全文数据库、中国生物医学文献数据库中关于老年肌少症患者营养管理措施的所有证据,检索文献类型包括指南、专家共识、临床决策、证据总结、系统评价或Meta分析,检索时间为建库至2022年1月20日。结果 共纳入18篇文献,包括1篇指南、1篇临床决策、6篇专家共识、10篇系统评价。总结了包含营养筛查和评估、营养素摄入、营养监测和健康教育4个类别的32条证据。结论 该研究总结了老年肌少症患者营养管理的最佳证据,证据总结过程科学、严谨和全面。医护人员应结合实际情境和患者个体因素选择最佳证据,指导老年肌少症患者安全有效地改善机体营养状况,提高生活质量。