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

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dc.contributor.authorDaly, Louise E.
dc.contributor.authorNí Bhuachalla, Éadaoin B.
dc.contributor.authorPower, Derek G.
dc.contributor.authorCushen, Samantha J.
dc.contributor.authorJames, Karl
dc.contributor.authorRyan, Aoife M.
dc.contributor.funderScience Foundation Ireland
dc.contributor.funderHealth Research Board
dc.date.accessioned2018-02-20T13:24:12Z
dc.date.available2018-02-20T13:24:12Z
dc.date.issued2018
dc.description.abstractBackground: 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.sponsorshipHealth Research Board (Clinical Research Facility (CRF-C)en
dc.description.statusPeer revieweden
dc.description.versionPublished Versionen
dc.format.mimetypeapplication/pdfen
dc.identifier.citationDaly, 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.12267en
dc.identifier.doi10.1002/jcsm.12267
dc.identifier.endpage11
dc.identifier.issn2190-5991
dc.identifier.issn2190-6009
dc.identifier.journaltitleJournal of Cachexia, Sarcopenia and Muscleen
dc.identifier.startpage1
dc.identifier.urihttps://hdl.handle.net/10468/5502
dc.language.isoenen
dc.publisherJohn Wiley & Sons, Inc.en
dc.relation.projectinfo:eu-repo/grantAgreement/SFI/SFI Research Centres/12/RC/2273/IE/Alimentary Pharmabiotic Centre (APC) - Interfacing Food & Medicine/
dc.relation.urihttp://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.urihttps://creativecommons.org/licenses/by-nc-nd/4.0/
dc.subjectBody compositionen
dc.subjectSarcopeniaen
dc.subjectCachexiaen
dc.subjectMuscle attenuationen
dc.subjectCanceren
dc.subjectForeguten
dc.titleLoss of skeletal muscle during systemic chemotherapy is prognostic of poor survival in patients with foregut canceren
dc.typeArticle (peer-reviewed)en
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