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The role of computed tomography in evaluating body composition and the influence of reduced muscle mass on clinical outcome in abdominal malignancy: a systematic review

Abstract

It is estimated that there were 3.45 million new cases and 1.75 million deaths from cancer in Europe in 2012. Colorectal cancer was one of the most common cancers, accounting for 13% of new cases and 12.2% of all deaths. Conditions causing reduced muscle mass, such as sarcopenia, can increase the morbidity and mortality of people with cancer. Computed tomography (CT) scans can provide accurate, high-quality information on body composition, including muscle mass. To date, there has been no systematic review on the role of CT scans in identifying sarcopenia in abdominal cancer. This review aimed to examine the role of CT scans in determining the influence of reduced muscle mass on clinical outcome in abdominal cancer. A systematic review of English-language articles published in 2000 or later was conducted. Articles included cohort, randomised controlled trials and validation studies. Participants were people diagnosed with abdominal cancer who had undergone a CT scan. Data extraction and critical appraisal were undertaken. Ten cohort studies met the inclusion criteria. Seven studies demonstrated that low muscle mass was significantly associated with poor clinical outcome, with six specifically demonstrating reduced survival rates. Eight studies demonstrated that a greater number of patients (27.3–66.7%) were identified as sarcopenic using CT scans compared with numbers identified as malnourished using body mass index. CT scans can identify reduced muscle mass and predict negative cancer outcomes in people with abdominal malignancies, where traditional methods of assessment are less effective.

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References

  1. Ferlay J, Steliarova-Foucher E, Lortet-Tieulent J, Rosso S, Coebergh JWW, Comber H et al. Cancer incidence and mortality patterns in Europe: estimates for 40 countries in 2012. Eur J Cancer 2013; 49: 1374–1403.

    CAS  Article  Google Scholar 

  2. De Angelis R, Sant M, Coleman MP, Francisci S, Baili P, Pierannunzio D et al. Cancer survival in Europe 1999-2007 by country and age: results of EUROCARE-5-a population-based study. Lancet Oncol 2014; 15: 23–34.

    Article  Google Scholar 

  3. Lanzieri G . The greying of the baby boomers: a century-long view of ageing in European populations. Stat Focus Eurostat 2011; 23 (Population and social conditions), 1–11.

    Google Scholar 

  4. Ferlay J, Autier P, Boniol M, Heanue M, Colombet M, Boyle P . Estimates of the cancer incidence and mortality in Europe in 2006. Ann Oncol 2007; 18: 581–592.

    CAS  Article  Google Scholar 

  5. Lis CG, Gupta D, Lammersfeld CA, Markman M, Vashi PG . Role of nutritional status in predicting quality of life outcomes in cancer—a systematic review of the epidemiological literature. Nutr J 2012; 11: 27.

    Article  Google Scholar 

  6. Gupta D, Vashi PG, Lammersfeld CA, Braun DP . Role of nutritional status in predicting the length of stay in cancer: a systematic review of the epidemiological literature. Ann Nutr Metab 2011; 59: 96–106.

    CAS  Article  Google Scholar 

  7. Marin Caro MM, Laviano A, Pichard C . Impact of nutrition on quality of life during cancer. Curr Opin Clin Nutr Metab Care 2007; 10: 480–487.

    Article  Google Scholar 

  8. Madden AM, Smith S . Body composition and morphological assessment of nutritional status in adults: a review of anthropometric variables. J Hum Nutr Diet 2014, e-pub ahead of print 25 November 2014; doi:10.1111/jhn.12278.

  9. Evans WJ, Morley JE, Argiles J, Bales C, Baracos V, Guttridge D et al. Cachexia: a new definition. Clin Nutr 2008; 27: 793–799.

    CAS  Article  Google Scholar 

  10. Baracos V, Kazemi-Bajestani SMR . Clinical outcomes related to muscle mass in humans with cancer and catabolic illnesses. Int J Biochem Cell Biol 2013; 45: 2302–2308.

    CAS  Article  Google Scholar 

  11. Vandewoude M . Nutritional assessment in geriatric cancer patients. Support Care Cancer 2010; 18: S51–S56.

    Article  Google Scholar 

  12. Muscaritoli M, Anker SD, Argiles J, Aversa Z, Bauer JM, Biolo G et al. Consensus definition of sarcopenia, cachexia and pre-cachexia: joint document elaborated by Special Interest Groups (SIG) "cachexia-anorexia in chronic wasting diseases" and "nutrition in geriatrics". Clin Nutr 2010; 29: 154–159.

    CAS  Article  Google Scholar 

  13. Cruz-Jentoft AJ, Baeyens JP, Bauer JM, Boirie Y, Cederholm T, Landi F et al. Sarcopenia: European consensus on definition and diagnosis: report of the European Working Group on Sarcopenia in Older People. Age Ageing 2010; 39: 412–423.

    Article  Google Scholar 

  14. Androutsos O, Gerasimidis K, Karanikolou A, Reilly JJ, Edwards CA . Impact of eating and drinking on body composition measurements by bioelectrical impedance. J Hum Nutr Diet 2014, e-pub ahead of print 26 August 2014; doi:10.1111/jhn.12259.

  15. Gaba A, Kapus O, Cuberek R, Botek M . Comparison of multi- and single-frequency bioelectrical impedance analysis with dual-energy X-ray absorptiometry for assessment of body composition in post-menopausal women: effects of body mass index and accelerometer-determined physical activity. J Hum Nutr Diet 2014, e-pub ahead of print 7 July 2014; doi:10.1111/jhn.12257.

  16. Klein S, Kinney J, Jeejeebhoy K, Alpers D, Hellerstein M, Murray M et al. Nutrition support in clinical practice: review of published data and recommendations for future research directions. Summary of a conference sponsored by the National Institutes of Health, American Society for Parenteral and Enteral Nutrition, and American Society for Clinical Nutrition. Am J Clin Nutr 1997; 66: 683–706.

    CAS  Article  Google Scholar 

  17. Goodpaster BH, Thaete FL, Kelley DE . Composition of skeletal muscle evaluated with computed tomography. Ann NY Acad Sci 2000; 904: 18–24.

    CAS  Article  Google Scholar 

  18. Borkan GA, Gerzof SG, Robbins AH, Hults DE, Silbert CK, Silbert JE . Assessment of abdominal fat content by computed tomography. Am J Clin Nutr 1982; 36: 172–177.

    CAS  Article  Google Scholar 

  19. Ashwell M, Cole TJ, Dixon AK . Obesity: new insight into the anthropometric classification of fat distribution shown by computed tomography. Br Med J 1985; 290: 1692–1694.

    CAS  Article  Google Scholar 

  20. Plourde G . The role of radiologic methods in assessing body composition and related metabolic parameters. Nutr Rev 1997; 55: 289–296.

    CAS  Article  Google Scholar 

  21. Lustgarten MS, Fielding RA . Assessment of analytical methods used to measure changes in body composition in the elderly and recommendations for their use in phase II clinical trials. J Nutr Health Aging 2011; 15: 368–375.

    CAS  Article  Google Scholar 

  22. Walsh L, Shore R, Auvinen A, Jung T, Wakeford R . Risks from CT scans-what do recent studies tell us? J Radiol Protect 2014; 34: E1.

    Article  Google Scholar 

  23. Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gotzsche PC, Ioannidis JPA et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration. BMJ 2009; 339: b2700.

    Article  Google Scholar 

  24. Elia M, Russell CA . Combating malnutrition: recommendations for action. British Association for Parenteral and Enteral Nutrition 2009; Report from the advisory group on malnutrition led by BAPEN: E-Print. Available from. http://eprints.soton.ac.uk/id/eprint/153643.

  25. Kondrup J, Allison SP, Elia M, Vellas B, Plauth M,, Educational and Clinical Practice Committee, European Society for Parenteral and Enteral Nutrition (ESPEN).. ESPEN guidelines for nutrition screening 2002. Clin Nutr 2003; 22: 415–421.

    CAS  Article  Google Scholar 

  26. Cochrane Consumers and Communication Review Group A. Data extraction template. Available from http://cccrg.cochrane.org/author-resources2013.

  27. Ishii Y, Hasegawa H, Nishibori H, Watanabe M, Kitajima M . Impact of visceral obesity on surgical outcome after laparoscopic surgery for rectal cancer. Br J Surg 2005; 92: 1261–1262.

    CAS  Article  Google Scholar 

  28. Balentine CJ, Enriquez J, Fisher W, Hodges S, Bansal V, Sansgiry S et al. Intra-abdominal fat predicts survival in pancreatic cancer. J Gastrointest Surg 2010; 14: 1832–1837.

    Article  Google Scholar 

  29. Nakamura K, Hongo A, Kodama J, Hiramatsu Y . Fat accumulation in adipose tissues as a risk factor for the development of endometrial cancer. Oncol Rep 2011; 26: 65–71.

    PubMed  Google Scholar 

  30. Clark W, Siegel EM, Chen YA, Zhao X, Parsons CM, Hernandez JM et al. Quantitative measures of visceral adiposity and body mass index in predicting rectal cancer outcomes after neoadjuvant chemoradiation. J Am Coll Surg 2013; 216: 1070–1081.

    Article  Google Scholar 

  31. Sabel MS, Terjimanian M, Conlon ASC, Griffith KA, Morris AM, Mulholland MW et al. Analytic morphometric assessment of patients undergoing colectomy for colon cancer. J Surg Oncol 2013; 108: 169–175.

    Article  Google Scholar 

  32. Moon HG, Ju YT, Jeong CY, Jung EJ, Lee YJ, Hong SC et al. Visceral obesity may affect oncologic outcome in patients with colorectal cancer. Ann Surg Oncol 2008; 15: 1918–1922.

    Article  Google Scholar 

  33. Mathur A, Hernandez J, Shaheen F, Shroff M, Dahal S, Morton C et al. Preoperative computed tomography measurements of pancreatic steatosis and visceral fat: prognostic markers for dissemination and lethality of pancreatic adenocarcinoma. HPB (Oxford) 2011; 13: 404–410.

    Article  Google Scholar 

  34. Torres ML, Hartmann LC, Cliby WA, Kalli KR, Young PM, Weaver AL et al. Nutritional status, CT body composition measures and survival in ovarian cancer. Gynecol Oncol 2013; 129: 548–553.

    Article  Google Scholar 

  35. Seki Y, Ohue M, Sekimoto M, Takiguchi S, Takemasa I, Ikeda M et al. Evaluation of the technical difficulty performing laparoscopic resection of a rectosigmoid carcinoma: visceral fat reflects technical difficulty more accurately than body mass index. Surg Endosc 2007; 21: 929–934.

    CAS  Article  Google Scholar 

  36. Oh T-H, Byeon J-S, Myung S-J, Yang S-K, Choi K-S, Chung J-W et al. Visceral obesity as a risk factor for colorectal neoplasm. J Gastroenterol Hepatol 2008; 23: 411–417.

    CAS  Article  Google Scholar 

  37. Murphy RA, Wilke MS, Perrine M, Pawlowicz M, Mourtzakis M, Lieffers JR et al. Loss of adipose tissue and plasma phospholipids: Relationship to survival in advanced cancer patients. Clin Nutr 2010; 29: 482–487.

    CAS  Article  Google Scholar 

  38. Prado CM, Sawyer MB, Ghosh S, Lieffers JR, Esfandiari N, Antoun S et al. Central tenet of cancer cachexia therapy: do patients with advanced cancer have exploitable anabolic potential? Am J Clin Nutr 2013; 98: 1012–1019.

    CAS  Article  Google Scholar 

  39. Lieffers JR, Mourtzakis M, Hall KD, McCargar LJ, Prado CM, Baracos VE . A viscerally driven cachexia syndrome in patients with advanced colorectal cancer: contributions of organ and tumor mass to whole-body energy demands. Am J Clin Nutr 2009; 89: 1173–1179.

    CAS  Article  Google Scholar 

  40. Di Sebastiano KM, Yang L, Zbuk K, Wong RK, Chow T, Koff D et al. Accelerated muscle and adipose tissue loss may predict survival in pancreatic cancer patients: the relationship with diabetes and anaemia. Br J Nutr 2013; 109: 302–312.

    CAS  Article  Google Scholar 

  41. Lieffers JR, Bathe OF, Fassbender K, Winget M, Baracos VE . Sarcopenia is associated with postoperative infection and delayed recovery from colorectal cancer resection surgery. Br J Cancer 2012; 107: 931–936.

    CAS  Article  Google Scholar 

  42. Parsons HA, Tsimberidou AM, Pontikos M, Fu S, Hong D, Wen S et al. Evaluation of the clinical relevance of body composition parameters in patients with cancer metastatic to the liver treated with hepatic arterial infusion chemotherapy. Nutr Cancer 2012; 64: 206–217.

    CAS  Article  Google Scholar 

  43. Richards CH, Roxburgh CS, MacMillan MT, Isswiasi S, Robertson EG, Guthrie GK et al. The relationships between body composition and the systemic inflammatory response in patients with primary operable colorectal cancer. PLoS One 2012; 7: e41883.

    CAS  Article  Google Scholar 

  44. van Vledder MG, Levolger S, Ayez N, Verhoef C, Tran TCK, IJzermans JNM . Body composition and outcome in patients undergoing resection of colorectal liver metastases. Br J Surg 2012; 99: 550–557.

    CAS  Article  Google Scholar 

  45. Martin L, Martin L, Birdsell L, Macdonald N, Reiman T, Clandinin MT et al. Cancer cachexia in the age of obesity: skeletal muscle depletion is a powerful prognostic factor, independent of body mass index. J Clin Oncol 2013; 31: 1539–1547.

    Article  Google Scholar 

  46. Mourtzakis M, Prado CM, Lieffers JR, Reiman T, McCargar LJ, Baracos VE . A practical and precise approach to quantification of body composition in cancer patients using computed tomography images acquired during routine care. Appl Physiol Nutr Metab 2008; 33: 997–1006.

    Article  Google Scholar 

  47. Prado CM, Liefers JR, McCargar LJ, Reiman T, Sawyer MB, Martin L et al. Prevalence and clinical implications of sarcopenic obesity in patients with solid tumours of the respiratory and gastrointestinal tracts: a population-based study. Lancet Oncol 2008; 9: 629–635.

    Article  Google Scholar 

  48. Thoresen L, Frykholm G, Lydersen S, Ulveland H, Baracos V, Prado CMM et al. Nutritional status, cachexia and survival in patients with advanced colorectal carcinoma. Different assessment criteria for nutritional status provide unequal results. Clin Nutr 2013; 32: 65–72.

    CAS  Article  Google Scholar 

  49. Barret M, Antoun S, Dalban C, Malka D, Mansourbakht T, Zaanan A et al. Sarcopenia is linked to treatment toxicity in patients with metastatic colorectal cancer. Nutr Cancer 2014; 66: 583–589.

    CAS  Article  Google Scholar 

  50. Shen W, Punyanitya M, Wang Z, Gallagher D, St-Onge MP, Albu J et al. Total body skeletal muscle and adipose tissue volumes: estimation from a single abdominal cross-sectional image. J Appl Physiol 2004; 97: 2333–2338.

    Article  Google Scholar 

  51. Baumgartner RN . Epidemiology of sarcopenia among the elderly in New Mexico (vol 147, pg 755, 1998). Am J Epidemiol 1999; 149: 1161–1161.

    Google Scholar 

  52. Correia Horvath JD, Dias de Castro ML, Kops N, Kruger Malinoski N, Friedman R . Obesity coexists with malnutrition? Adequacy of food consumption by severely obese patients to dietary reference intake recommendations. Nutr Hosp 2014; 29: 292–299.

    PubMed  Google Scholar 

  53. Malietzis G, Aziz O, Bagnall NM, Johns N, Fearon KC, Jenkins JT . The role of body composition evaluation by computerized tomography in determining colorectal cancer treatment outcomes: a systematic review. Eur J Surg Oncol 2014; 41: 186–196.

    Article  Google Scholar 

  54. Batsis JA, Mackenzie TA, Barre LK, Lopez-Jimenez F, Bartels SJ . Sarcopenia sarcopenic obesity and mortality in older adults: results from the National Health and Nutrition Examination Survey III. Eur J Clin Nutr 2014; 68: 1001–1007.

    CAS  Article  Google Scholar 

  55. Peng S, Plank LD, McCall JL, Gillanders LK, McIlroy K, Gane EJ . Body composition, muscle function, and energy expenditure in patients with liver cirrhosis: a comprehensive study. Am J Clin Nutr 2007; 85: 1257–1266.

    CAS  Article  Google Scholar 

  56. Nutritional status in cirrhosis. Italian Multicentre Cooperative Project on Nutrition in Liver Cirrhosis. J Hepatol 1994; 21: 317–325.

  57. Fearon K, Strasser F, Anker SD, Bosaeus I, Bruera E, Fainsinger RL et al. Definition and classification of cancer cachexia: an international consensus. Lancet Oncol 2011; 12: 489–495.

    Article  Google Scholar 

  58. Muller MJ, Geisler C, Pourhassan M, Gluer CC, Bosy-Westphal A . Assessment and definition of lean body mass deficiency in the elderly. Eur J Clin Nutr 2014; 68: 1220–1227.

    CAS  Article  Google Scholar 

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Gibson, D., Burden, S., Strauss, B. et al. The role of computed tomography in evaluating body composition and the influence of reduced muscle mass on clinical outcome in abdominal malignancy: a systematic review. Eur J Clin Nutr 69, 1079–1086 (2015). https://doi.org/10.1038/ejcn.2015.32

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