The additional benefit of computed tomography in cancer patients: impacts of sarcopenia and cachexia on quality of life during chemotherapy / O benefício adicional da tomografia computadorizada no paciente oncológico: impactos da sarcopenia e caquexia na qualidade de vida durante a quimioterapia

Abstract Objective: This study evaluates the effects of sarcopenia and cachexia on the quality of life (QoL) of patients with gastrointestinal cancer during their initial cycle of chemotherapy, emphasizing the significance of computed tomography (CT) in assessing muscle mass. Materials and Methods: In this prospective study, we evaluated 60 adult patients with gastrointestinal cancer who started chemotherapy between January and December of 2017. Sarcopenia was diagnosed on the basis of CT findings, and QoL was assessed with the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30. Results: The mean age was 60.9 years, and 33 (55.0%) of the patients were men. Of the 60 patients, 33 (55.0%) had cachexia and 14 (23.3%) had sarcopenia. Chemotherapy significantly reduced QoL, particularly in the physical, role functioning, and social domains, with no differences between the cachexia and sarcopenia groups. Conclusion: Among patients with gastrointestinal cancer submitted to chemotherapy, the chemotherapy-induced decline in QoL does not seem to differ significantly between those with cachexia or sarcopenia, as classified by CT-measured muscle mass, and those without. However, CT-based muscle mass evaluation remains crucial for guiding customized intervention strategies. Integrating this evaluation in radiological reports can provide valuable insights for planning specific care, thus improving patient QoL during treatment.

Resumo Objetivo: Este estudo avalia os efeitos da sarcopenia e da caquexia na qualidade de vida de pacientes com câncer gastrointestinal durante o ciclo inicial de quimioterapia, enfatizando a importância da tomografia computadorizada (TC) na avaliação da massa muscular. Materiais e Métodos: Estudo prospectivo com 60 pacientes adultos com câncer gastrointestinal que iniciaram quimioterapia de janeiro a dezembro de 2017. A TC foi utilizada para o diagnóstico de sarcopenia e o Quality of Life Questionnaire Core 30 da European Organization for Research and Treatment of Cancer foi utilizado para avaliar a qualidade de vida. Resultados: A média de idade dos pacientes foi 60,9 anos e 33 (55%) eram homens. Entre os pacientes, 33 (55%) eram caquéticos e 14 (24%) eram sarcopênicos. A quimioterapia reduziu significativamente a qualidade de vida, especialmente nos domínios físico, de desempenho de papéis e social, sem diferenças entre os grupos caquéticos e sarcopênicos. Conclusão: A diminuição da qualidade de vida não difere significativamente entre pacientes caquéticos/sarcopênicos e não caquéticos/não sarcopênicos com câncer gastrointestinal submetidos a quimioterapia, conforme classificado pela massa muscular medida por TC. No entanto, a avaliação da massa muscular por TC continua crucial para orientar estratégias de intervenção personalizadas. A integração dessa avaliação nos laudos radiológicos pode fornecer informações valiosas para o planejamento de cuidados específicos, melhorando a qualidade de vida dos pacientes durante o tratamento.

Low skeletal muscle radiodensity is the best predictor for short-term major surgical complications in gastrointestinal surgical cancer: A cohort study.

The aim of this study was to evaluate whether body composition, muscle function, and their association are predictive factors for short-term postoperative complications in patients with gastric and colorectal cancer. A prospective cohort study was conducted with patients undergoing resection of gastric and colorectal tumors. Nutritional status was assessed using Patient-Generated Subjective Global Assessment (PG-SGA) and anthropometric techniques. Low handgrip strength (HGS) was observed when <16kg for women, and <27kg for men. Computed tomography images were used to measure visceral adipose tissue, skeletal muscle index (SMI), and skeletal muscle radiodensity (SMD). Complications of grade II or above (according to Clavien-Dindo's classification) were considered in a follow-up period of up to 30 days after surgery. Major complications were defined when they reached grade III or above. A total of 84 patients were analyzed (57.1% female, 59.7 ± 12.6 years) and 19% were diagnosed with low HGS + low SMI or SMD. Postoperative complications occurred in 51.2%, and these patients presented significantly longer duration of surgery and hospital stay. Major complications were observed in 16.7% of the total number of patients. Binary logistic regression adjusted by age, sex, and tumor staging showed that low SMD, low HGS + low SMI or SMD, and obesity were independent risk factors for postoperative complications, but only low SMD was an independent risk factor for major postoperative complications. Low SMD is an independent risk factor for short-term major complications following surgery in patients with gastric and colorectal cancer.

Agreement between software programmes of body composition analyses on abdominal computed tomography scans of obese adults

ABSTRACT Objective A large number of studies have used abdominal computed tomography (CT) to quantify body composition, and different software programmes have been used to perform these analyses. Thus, this comparison is important to enable researchers to know the performance of more accessible software. Subjects and methods Fifty-four abdominal CT scans of obese (BMI 30 to 39.9 kg/m2), sedentary adults (24-41 years) patients from a Brazilian single center were selected. Two software programs were compared: Slice-O-Matic (Tomovision, Canada) version 5.0 and OsiriX version 5.8.5. The body composition analysis were segmented using standard Hounsfield unit (HU) (adipose tissue: -190 to +30 and skeletal muscle: -29 to +150) and measured at the mid third lumbar vertebra (L3) level on a slice showing both transversal processes. Bland-Altman limits of agreement analyses were used to assess the level of agreement between Slice-O-Matic and OsiriX. Results A total of fifty-four participants were evaluated, with majority women (69%), mean of age 31.3 (SD 6.5) years and obesity grade I most prevalent (74.1%). The agreement, in Bland-Altman analysis, between Slice-O-Matic and OsiriX analisys for the muscle mass tissue, visceral adipose tissue and subcutaneous adipose tissue were excellent (≥ 0.954) with P-values < 0.001. Conclusion These findings show that Slice-O-Matic and OsiriX softwares agreement in measurements of skeletal muscle and adipose tissue and sarcopenia diagnosis in obese patients, suggesting good applicability in studies with body composition in this population and clinical practice.