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Body composition, energy expenditure and physical activity

A comparison of CT based measures of skeletal muscle mass and density from the Th4 and L3 levels in patients with advanced non-small-cell lung cancer

European Journal of Clinical Nutrition volume 73, pages 1069–1076 (2019)Cite this article

Subjects

Abstract

Background:

Muscle mass and density assessed from CT-images at the L3 level are prognostic for survival and predict toxicity in cancer patients. However, L3 is not always included on routine CT-scans. We aimed to investigate whether images at the Th4 level may be used instead.

Methods:

Patients from three chemotherapy trials in advanced NSCLC were eligible (n = 1305). Skeletal muscle area (cm2), skeletal muscle index (SMI, cm2/m2) and skeletal muscle density (SMD) at Th4 and L3 levels were assessed from baseline CT-scans. SMI and SMD at the Th4 and L3 level were transformed into z-scores and the agreement between scores was investigated by Bland–Altman plots and estimated by intra-class correlation analyses. Linear regression was used to test if Th4 SMI and SMD z-scores predicted L3 SMI and SMD z-scores.

Results:

CT-images from 401 patients were analysable at both levels. There was a moderate agreement between Th4 and L3 SMI z-scores with an intra-class correlation of 0.71 (95% CI 0.64–0.77) for men and 0.53 (95% CI 0.41–0.63) for women. Regression models predicting L3 SMI z-scores from Th4 SMI z-scores showed coefficients of 0.71 (95% CI 0.62–0.80) among men and 0.53 (95% CI 0.40–0.66) among women. R-squares were 0.51 and 0.28, respectively, indicating moderate agreement. A similar, moderate agreement between Th4 and L3 SMD z-scores was observed.

Conclusion:

There was only moderate agreement between muscle measures from Th4 and L3 levels, indicating that missing data from the L3 level cannot be replaced by analysing images at the Th4 level.

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Acknowledgements

We want to thank Rachel Murphy (PhD) and Nina Esfandiari (B.Sc) both at Department of Oncology, University of Alberta, Canada, for their participation in the body composition analyses. Thanks to Nina Helbekkmo and Ingrid Sandstad for handling the collection of CT scans from the RCT1. We also thank the Departments of Radiology at Haukeland University Hospital, Bergen, St Olav University Hospital, Trondheim and Hamar, Gjøvik and Kongsvinger Hospital, Innlandet Hospital HF, as well as the following and their respective Departments of Radiology for their participation in the collection of CT scans: Bjørn Wembstad, Hammerfest Hospital and Kåre Hansen, Kirkenes Hospital; Helse Finnmark HF. Nina Helbekkmo, University Hospital North Norway Tromsø and Nada Zafran Groh, University Hospital North Norway Harstad; University Hospital North Norway HF. Heinrich Backmann, Nordland Hospital Bodø and Finn Larsen Aas, Nordland Hospital Vesterålen; Nordland Hospital HF. Kristina Helander, Helgeland Hospital Mo i Rana, Hans Henrik Strøm, Helgeland Hospital Sandnessjøen, Reidar Berntsen Helgeland, Hospital Mosjøen; Helgeland Hospital HF. Randi Sudbø, Namsos Hospital and Thor Naustdal, Levanger Hospital; Nord Trøndelag HF. Bjørn Jakobsen, Molde Hospital, Finn Wammer, Ålesund Hospital, Ivar Blix, Kristiansund Hospital and Inge Eskeland, Volda Hospital; Helse Møre og Romsdal HF. Anita Spikkeland, Voss Hospital; Helse Bergen HF. Tesfaye Madebo and Oddveig Garpestad, Stavanger University Hospital HF, Sverre Fluge, Haugesund Hospital; Helse Fonna HF. Frode Ramslien, Telemark Hospital Skien and Oddvar Øygarden, Telemark Hospital Rjukan; Telemark Hospital HF. Heidi Rolke Sørlandet Hospital Kristiansand and Terje Torp, Sørlandet Hospital Arendal; Sørlandet Hospital HF. Karin Semb, Vestfold Hospital Tønsberg; Vestfold Hospital HF. Per Fredrik Ekholdt, Østfold Hospital Fredrikstad; Østfold Hospital HF. Ellinor Heitman, Ringerike Hospital, Leiv Rusten, Drammen Hospital, Martin Cornelius Ruppert, Bærum Hospital, and Peter Gottschalk, Kongsberg Hospital; Vestre Viken HF. Anders Fjeld, Oslo University Hospital (OUS) Aker, Odd Terje Brustugun and Paal Fr Brunsvig, OUS Radiumhospitalet, Kjersti Hornslien and Frøydis Stornes, OUS Ullevål; OUS HF. Svein Olav Saxrud, Akershus University Hospital HF. Carl Birger Alm, Lovisenberg Hospital Oslo.

Funding:

The study was funded by the South-Eastern Norway Regional Health Authority. The collection of CT scans was supported by unrestricted grants from Pierre Fabre, Norway. The Canadian participation in the body composition analyses was supported by the Canadian Institute of Health Research and Alberta Cancer Foundation.

Author information

Authors and Affiliations

  1. Faculty of Medicine, Department of Clinical and Molecular Medicine, NTNU, Norwegian University of Science and Technology, Trondheim, Norway

    Bjørn H. Grønberg

  2. The Cancer Clinic, St. Olav’s Hospital, Trondheim University Hospital, Trondheim, Norway

    Bjørn H. Grønberg

  3. Department of Oncology, Oslo University Hospital, Oslo, Norway

    Bjørg Sjøblom & Nina Aass

  4. Norwegian Centre for Violence and Traumatic Stress Studies, Oslo, Norway

    Tore Wentzel-Larsen

  5. Centre for Child and Adolescent Mental Health, Eastern and Southern Norway, Oslo, Norway

    Tore Wentzel-Larsen

  6. Centre for Clinical Research, Haukeland University Hospital, Bergen, Norway

    Tore Wentzel-Larsen

  7. Division of Palliative Care Medicine, Department of Oncology, University of Alberta, Edmonton, Canada

    Vickie E. Baracos

  8. Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway

    Marianne J. Hjermstad, Nina Aass & Marit Jordhøy

  9. Department of Oncology, European Palliative Care Research Centre, Oslo University Hospital, Oslo, Norway

    Marianne J. Hjermstad & Asta Bye

  10. Department of Oncology, University Hospital of North Norway, Tromsø, Norway

    Roy M. Bremnes

  11. Faculty of Medicine, Department of Clinical Medicine, UiT - The Arctic University of Norway, Tromsø, Norway

    Roy M. Bremnes

  12. Department of Thoracic Medicine, Haukeland University Hospital, Bergen, Norway

    Øystein Fløtten

  13. Faculty of Health Sciences, Department of Nursing and Health Promotion, Oslo Metropolitan University, Oslo, Norway

    Asta Bye

  14. Department of Internal Medicine, Innlandet Hospital Trust, Hamar, Norway

    Marit Jordhøy

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  1. Bjørn H. Grønberg
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  2. Bjørg Sjøblom
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Correspondence to Bjørn H. Grønberg.

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Grønberg, B.H., Sjøblom, B., Wentzel-Larsen, T. et al. A comparison of CT based measures of skeletal muscle mass and density from the Th4 and L3 levels in patients with advanced non-small-cell lung cancer. Eur J Clin Nutr 73, 1069–1076 (2019). https://doi.org/10.1038/s41430-018-0325-5

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