Assessment of sarcopenia in patients with upper gastrointestinal tumors: Prevalence and agreement between computed tomography and dual-energy x-ray absorptiometry.

BACKGROUND & AIMS: Sarcopenia is associated with an increased risk of complications to treatment and lower survival rates in patients with cancer, but there is a lack of agreement on cut-off values and assessment methods. We aimed to investigate the prevalence of sarcopenia assessed by dual-energy x-ray absorptiometry (DXA) and computed tomography (CT) as well as the agreement between the methods for identification of sarcopenia. METHODS: This cross-sectional study pooled data from two studies including patients scheduled for surgery for gastrointestinal tumors. We assessed sarcopenia using two different cut-off values derived from healthy young adults for DXA and two for CT. Additionally, we used one of the most widely applied cut-off values for CT assessed sarcopenia derived from obese cancer patients. The agreement between DXA and CT was evaluated using Cohen's kappa. The mean difference and range of agreement between DXA and CT for estimating total and appendicular lean soft tissue were assessed using Bland-Altman plots. RESULTS: In total, 131 patients were included. With DXA the prevalence of sarcopenia was 11.5% and 19.1%. Using CT, the prevalence of sarcopenia was 3.8% and 26.7% using cut-off values from healthy young adults and 64.1% using the widely applied cut-off value. The agreement between DXA and CT in identifying sarcopenia was poor, with Cohen's kappa values ranging from 0.05 to 0.39. The mean difference for estimated total lean soft tissue was 1.4 kg, with 95% limits of agreement from -8.6 to 11.5 kg. For appendicular lean soft tissue, the ratio between DXA and CT was 1.15, with 95% limits of agreement from 0.92 to 1.44. CONCLUSIONS: The prevalence of sarcopenia defined using DXA and CT varied substantially, and the agreement between the two modalities is poor.

Interval Walking Improves Glycemic Control and Body Composition After Cancer Treatment: A Randomized Controlled Trial.

CONTEXT: Patients with colorectal cancer have increased risk of metabolic diseases including diabetes. Exercise training may counteract metabolic dysregulation, but the impact of exercise training on glycemic control, including postprandial glycemia, has never been explored in patients with colorectal cancer. OBJECTIVE: To examine the effects of home-based interval walking on aerobic and metabolic fitness and quality of life in patients with colorectal cancer. DESIGN: Randomized controlled trial. SETTING: Clinical research center. PARTICIPANTS: Thirty-nine sedentary (<150 minutes moderate-intensity exercise per week) patients with stage I to III colorectal cancer who had completed primary treatment. INTERVENTION: Home-based interval walking 150 min/wk or usual care for 12 weeks. MAIN OUTCOME MEASURES: Changes from baseline to week 12 in maximum oxygen uptake (VO2peak) by cardiopulmonary exercise test, glycemic control by oral glucose tolerance test (OGTT), body composition by dual-energy x-ray absorptiometry scan, blood biochemistry, and quality of life. RESULTS: Compared with control, interval walking had no effect on VO2peak [mean between-group difference: -0.32 mL O2 · kg-1 · min-1 (-2.09 to 1.45); P = 0.721] but significantly improved postprandial glycemic control with lower glucose OGTT area under the curve [-126 mM · min (-219 to -33); P = 0.009], 2-hour glucose concentration [-1.1 mM (-2.2 to 0.0); P = 0.056], and improved Matsuda index [1.94 (0.34; 3.54); P = 0.01]. Also, interval walking counteracted an increase in fat mass in the control group [-1.47 kg (-2.74 to -0.19); P = 0.025]. CONCLUSION: A home-based interval-walking program led to substantial improvements in postprandial glycemic control and counteracted fat gain in posttreatment patients with colorectal cancer, possibly providing an effective strategy for prevention of secondary metabolic diseases.

Exercise-mediated improvement of depression in patients with gastro-esophageal junction cancer is linked to kynurenine metabolism.

Background: Exercise may improve depression in cancer patients, yet the molecular mechanism behind this protection is poorly understood. Here, we aimed to explore the link between exercise and regulation of kynurenine (Kyn) metabolism and inflammation in patients with operable gastro-esophageal junction (GEJ) cancer patients, who improved significantly in depression score with exercise training. Material and Methods: Fifty GEJ cancer patients were allocated to 12 weeks of supervised training twice weekly including interval-based aerobic exercise and resistance training, or standard care. Depression score was evaluated by HADS, and blood samples and muscle biopsies were collected for determination of Kyn metabolism and inflammation across the intervention. Results: Depression scores decreased by -1.3 points in the exercise group (p < 0.01), whereas no changes were observed in the control group. Plasma 3-hydroxykynurenine (HK), a Kyn metabolite giving rise to other neurotoxic metabolites, increased by 48% (p <0.001) in the control group, while exercise training attenuated this accumulation. The production of HK is induced by inflammation, and while we observed no differences in systemic pro-inflammatory cytokines, exercise training ameliorated the treatment-induced intramuscular inflammation. Moreover, exercise has been suggested to convert Kyn to the neuroprotective metabolite, kynurenic acid (KA), but despite marked functional and muscular exercise-mediated adaptations, we did not observe any enhancement of KA production and related enzyme expression in the muscles of GEJ cancer patients. Conclusion: Exercise training reduced symptoms of depression in patients with GEJ cancer, and this effect was associated with an exercise-dependent attenuation of the inflammation-induced conversion of Kyn to neurotoxic metabolites.

Evaluating the Change in Axial Vertebral Rotation Following Thoracoscopic Anterior Scoliosis Surgery Using Low-Dose Computed Tomography.

BACKGROUND CONTEXT: In recent years, there has been increasing appreciation of the need to treat scoliosis as a three-dimensional deformity. PURPOSE: Assessment of surgical strategies and outcomes should consider not only the coronal plane correction but also derotation of the transverse plane deformity that can affect trunk appearance. STUDY DESIGN: This study included a cohort of 29 female adolescent idiopathic scoliosis patients who received thoracoscopic single rod anterior fusion (TASF) surgery. This study used pre- and postoperative low-dose computed tomographic (CT) scans to accurately measure apical axial vertebral rotation (AVR). METHODS: The pre- and postoperative values for clinically measured coronal Cobb correction and rib hump correction as well as AVR were compared to determine whether these values improved postoperatively. There are no conflicts of interest to report for authors of this investigation. RESULTS: As expected, statistically significant reductions in coronal Cobb angle (mean preoperative Cobb 51°, reducing to 24° at the two-year follow-up) and rib hump (mean preoperative rib hump 15°, reducing to 7° at two-year follow-up) were achieved. The mean reduction in apical AVR measured using CT was only 3° (mean preoperative AVR 16°, reducing to 13° at two-year follow-up), which was statistically but not clinically significant. Significant correlations were found between Cobb angle and rib hump, between Cobb angle and AVR, and between AVR and rib hump, suggesting that patients with greater coronal Cobb correction also achieve better derotation with this surgical procedure. CONCLUSIONS: The historical low-dose CT data set permitted detailed three-dimensional assessment of the deformity correction that is achieved using thoracoscopic anterior spinal fusion for progressive adolescent idiopathic scoliosis.