Loss of skeletal muscle during systemic chemotherapy is prognostic of poor survival in patients with foregut cancer

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dc.contributor.author Daly, Louise E.
dc.contributor.author Ní Bhuachalla, Éadaoin B.
dc.contributor.author Power, Derek G.
dc.contributor.author Cushen, Samantha J.
dc.contributor.author James, Karl
dc.contributor.author Ryan, Aoife M.
dc.date.accessioned 2018-02-20T13:24:12Z
dc.date.available 2018-02-20T13:24:12Z
dc.date.issued 2018
dc.identifier.citation Daly, L. E., Ní Bhuachalla, É. B., Power, D. G., Cushen, S. J., James, K. and Ryan, A. M. (2018) 'Loss of skeletal muscle during systemic chemotherapy is prognostic of poor survival in patients with foregut cancer', Journal of Cachexia, Sarcopenia and Muscle. doi: 10.1002/jcsm.12267 en
dc.identifier.startpage 1
dc.identifier.endpage 11
dc.identifier.issn 2190-5991
dc.identifier.issn 2190-6009
dc.identifier.uri http://hdl.handle.net/10468/5502
dc.identifier.doi 10.1002/jcsm.12267
dc.description.abstract Background: Malnutrition, weight loss, and muscle wasting are common in patients with foregut cancers (oesophagus, stomach, pancreas, liver, and bile ducts) and are associated with adverse clinical outcomes. However, little is known about the changes in body composition that occur in these patients during chemotherapy and its impacts clinical outcomes. Patients and methods: A prospective study of adult foregut cancer patients undergoing chemotherapy between 2012 and 2016 was conducted. Computed tomography images were evaluated for cross-sectional skeletal muscle area (SMA) and adipose tissue area (ATA) at two time points [interval 118 days (IQR 92–58 days)]. Longitudinal changes in SMA and ATA were examined using paired t-tests. Sarcopenia and low muscle attenuation (MA) were defined using published cut-points. Cox proportional hazards models were used to estimate mortality hazard ratios for key predictors. Results: A total of 225 foregut cancer patients were included (67% male, median age 66 years). At baseline, 40% were sarcopenic, 49% had low MA, and 62% had cancer cachexia. Longitudinal analysis (n = 163) revealed significant reductions in SMA [−6.1 cm2 (3.9%)/100 days, P < 0.001]. Patients treated with neoadjuvant chemotherapy experienced greater losses in SMA and skeletal muscle mass compared with patients receiving palliative chemotherapy [−6.6 cm2 (95%, confidence interval, CI: −10.2 to −3.1), P < 0.001 and −1.2 kg (95% CI: −1.8 to −0.5), P < 0.001, respectively]. Neither sarcopenia nor low MA at baseline was associated with reduced survival. A loss of SMA >6.0%/100 days (highest fourth) independently predicted overall survival in patients receiving palliative chemotherapy [hazard ratio: 2.66, (95% CI: 1.42 to 4.97), P = 0.002]. Conclusions: Patients with foregut cancers, particularly those treated with neoadjuvant chemotherapy, experience significant losses of muscle during chemotherapy. A high level of SMA loss is prognostic of reduced survival in patients treated with palliative chemotherapy. Multimodal interventions to stabilize or increase muscle mass and influence outcome warrant further investigation. en
dc.description.sponsorship Health Research Board (Clinical Research Facility (CRF-C) en
dc.format.mimetype application/pdf en
dc.language.iso en en
dc.publisher John Wiley & Sons, Inc. en
dc.relation.uri http://onlinelibrary.wiley.com/doi/10.1002/jcsm.12267/abstract
dc.rights © 2018, the Authors. Journal of Cachexia, Sarcopenia and Muscle published by John Wiley & Sons Ltd on behalf of the Society on Sarcopenia, Cachexia and Wasting DisordersJournal of Cachexia, Sarcopenia and Muscle(2018)Published online in Wiley Online Library (wileyonlinelibrary.com)DOI:10.1002/jcsm.12267This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium,provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made. en
dc.rights.uri https://creativecommons.org/licenses/by-nc-nd/4.0/
dc.subject Body composition en
dc.subject Sarcopenia en
dc.subject Cachexia en
dc.subject Muscle attenuation en
dc.subject Cancer en
dc.subject Foregut en
dc.title Loss of skeletal muscle during systemic chemotherapy is prognostic of poor survival in patients with foregut cancer en
dc.type Article (peer-reviewed) en
dc.internal.authorcontactother Aoife Ryan, Food and Nutritional Sciences, University College Cork, Cork, Ireland.+353-21-490-3000. Email: a.ryan@ucc.ie en
dc.internal.availability Full text available en
dc.description.version Published Version en
dc.contributor.funder Science Foundation Ireland
dc.contributor.funder Health Research Board
dc.description.status Peer reviewed en
dc.identifier.journaltitle Journal of Cachexia, Sarcopenia and Muscle en
dc.internal.IRISemailaddress a.ryan@ucc.ie en
dc.relation.project info:eu-repo/grantAgreement/SFI/SFI Research Centres/12/RC/2273/IE/Alimentary Pharmabiotic Centre (APC) - Interfacing Food & Medicine/


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© 2018, the Authors. Journal of Cachexia, Sarcopenia and Muscle published by John Wiley & Sons Ltd on behalf of the Society on Sarcopenia, Cachexia and Wasting DisordersJournal of Cachexia, Sarcopenia and Muscle(2018)Published online in Wiley Online Library (wileyonlinelibrary.com)DOI:10.1002/jcsm.12267This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium,provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made. Except where otherwise noted, this item's license is described as © 2018, the Authors. Journal of Cachexia, Sarcopenia and Muscle published by John Wiley & Sons Ltd on behalf of the Society on Sarcopenia, Cachexia and Wasting DisordersJournal of Cachexia, Sarcopenia and Muscle(2018)Published online in Wiley Online Library (wileyonlinelibrary.com)DOI:10.1002/jcsm.12267This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium,provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.
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