Low temporal muscle thickness is an independent poor prognostic factor in patients with brain metastases treated with radiosurgery
DOI:
https://doi.org/10.25305/unj.333521Keywords:
sarcopenia, temporal muscle thickness, radiosurgery, brain metastasesAbstract
Objective: The aim of this Bulgarian study was to determine the impact of temporal muscle thickness (TMT), a prognostic factor for sarcopenia, in patients with brain metastases (BMs) treated with radiosurgery.
Methods: A retrospective analysis was conducted using TMT values from planning brain magnetic resonance imaging (MRI) studies for 232 patients diagnosed with brain metastases originating from various histological solid tumors. These measurements were taken prior to their initial radiosurgery procedure, conducted between January 2021 and December 2022. The total TMT for both the left and right sides was calculated by summing them and then dividing by two to determine the average TMT. The cut-off value was determined for TMT based on the median of the measured values among all participants. Additionally, sarcopenia was assessed as an independent prognostic factor through Cox regression models that accounted for other relevant prognostic variables.
Results: In sarcopenia patients with a TMT below the cut-off values, specifically the median TMT (5.42 mm), the risk of death was significantly increased (HR = 6.310, 95% CI: 4.161–9.568, p < 0.001). In addition, sarcopenia was revealed to be an independent prognostic factor even after adjusting for gender, number of BMs, cancer type, and ECOG Performance Status (HR = 5.757, 95% CI: 3.717–8.915, p < 0.001). Patients with sarcopenia had a significantly shorter mean OS (5.46 months, 95% CI = 5.00–5.91) compared to those without sarcopenia (23.40 months, 95% CI = 20.62–26.18) (log-rank test P < 0.001).
Conclusions: In patients with BMs treated with radiosurgery, TMT from planning MRI studies serves as an independent prognostic marker and may help with patient stratification in future clinical trials.
References
1. Cagney DN, Martin AM, Catalano PJ, Redig AJ, Lin NU, Lee EQ, Wen PY, Dunn IF, Bi WL, Weiss SE, Haas-Kogan DA, Alexander BM, Aizer AA. Incidence and prognosis of patients with brain metastases at diagnosis of systemic malignancy: a population-based study. Neuro Oncol. 2017 Oct 19;19(11):1511-1521. [CrossRef] [PubMed] [PubMed Central]
2. Passiglia F, Caglevic C, Giovannetti E, Pinto JA, Manca P, Taverna S, Listì A, Gil-Bazo I, Raez LE, Russo A, Rolfo C. Primary and metastatic brain cancer genomics and emerging biomarkers for immunomodulatory cancer treatment. Semin Cancer Biol. 2018 Oct;52(Pt 2):259-268. [CrossRef] [PubMed]
3. Ostrom QT, Bauchet L, Davis FG, Deltour I, Fisher JL, Langer CE, Pekmezci M, Schwartzbaum JA, Turner MC, Walsh KM, Wrensch MR, Barnholtz-Sloan JS. The epidemiology of glioma in adults: a "state of the science" review. Neuro Oncol. 2014 Jul;16(7):896-913. [CrossRef] [PubMed] [PubMed Central]
4. Cruz-Jentoft AJ, Baeyens JP, Bauer JM, Boirie Y, Cederholm T, Landi F, Martin FC, Michel JP, Rolland Y, Schneider SM, Topinková E, Vandewoude M, Zamboni M; European Working Group on Sarcopenia in Older People. Sarcopenia: European consensus on definition and diagnosis: Report of the European Working Group on Sarcopenia in Older People. Age Ageing. 2010 Jul;39(4):412-23. [CrossRef] [PubMed] [PubMed Central]
5. Mintziras I, Miligkos M, Wächter S, Manoharan J, Maurer E, Bartsch DK. Sarcopenia and sarcopenic obesity are significantly associated with poorer overall survival in patients with pancreatic cancer: Systematic review and meta-analysis. Int J Surg. 2018 Nov;59:19-26. [CrossRef] [PubMed]
6. Ubachs J, Ziemons J, Minis-Rutten IJG, Kruitwagen RFPM, Kleijnen J, Lambrechts S, Olde Damink SWM, Rensen SS, Van Gorp T. Sarcopenia and ovarian cancer survival: a systematic review and meta-analysis. J Cachexia Sarcopenia Muscle. 2019 Dec;10(6):1165-1174. [CrossRef] [PubMed] [PubMed Central]
7. Simonsen C, de Heer P, Bjerre ED, Suetta C, Hojman P, Pedersen BK, Svendsen LB, Christensen JF. Sarcopenia and Postoperative Complication Risk in Gastrointestinal Surgical Oncology: A Meta-analysis. Ann Surg. 2018 Jul;268(1):58-69. [CrossRef] [PubMed]
8. McGovern J, Dolan RD, Horgan PG, Laird BJ, McMillan DC. Computed tomography-defined low skeletal muscle index and density in cancer patients: observations from a systematic review. J Cachexia Sarcopenia Muscle. 2021 Dec;12(6):1408-1417. [CrossRef] [PubMed] [PubMed Central]
9. Shachar SS, Williams GR, Muss HB, Nishijima TF. Prognostic value of sarcopenia in adults with solid tumours: A meta-analysis and systematic review. Eur J Cancer. 2016 Apr;57:58-67. [CrossRef] [PubMed]
10. Leitner J, Pelster S, Schöpf V, Berghoff AS, Woitek R, Asenbaum U, Nenning KH, Widhalm G, Kiesel B, Gatterbauer B, Dieckmann K, Birner P, Prayer D, Preusser M, Furtner J. High correlation of temporal muscle thickness with lumbar skeletal muscle cross-sectional area in patients with brain metastases. PLoS One. 2018 Nov 29;13(11):e0207849. [CrossRef] [PubMed] [PubMed Central]
11. Cho J, Park M, Moon WJ, Han SH, Moon Y. Sarcopenia in patients with dementia: correlation of temporalis muscle thickness with appendicular muscle mass. Neurol Sci. 2022 May;43(5):3089-3095. [CrossRef] [PubMed]
12. Furtner J, Berghoff AS, Albtoush OM, Woitek R, Asenbaum U, Prayer D, Widhalm G, Gatterbauer B, Dieckmann K, Birner P, Aretin B, Bartsch R, Zielinski CC, Schöpf V, Preusser M. Survival prediction using temporal muscle thickness measurements on cranial magnetic resonance images in patients with newly diagnosed brain metastases. Eur Radiol. 2017 Aug;27(8):3167-3173. [CrossRef] [PubMed] [PubMed Central]
13. Furtner J, Berghoff AS, Schöpf V, Reumann R, Pascher B, Woitek R, Asenbaum U, Pelster S, Leitner J, Widhalm G, Gatterbauer B, Dieckmann K, Höller C, Prayer D, Preusser M. Temporal muscle thickness is an independent prognostic marker in melanoma patients with newly diagnosed brain metastases. J Neurooncol. 2018 Oct;140(1):173-178. [CrossRef] [PubMed] [PubMed Central]
14. Furtner J, Genbrugge E, Gorlia T, Bendszus M, Nowosielski M, Golfinopoulos V, Weller M, van den Bent MJ, Wick W, Preusser M. Temporal muscle thickness is an independent prognostic marker in patients with progressive glioblastoma: translational imaging analysis of the EORTC 26101 trial. Neuro Oncol. 2019 Dec 17;21(12):1587-1594. [CrossRef] [PubMed] [PubMed Central]
15. Cruz-Jentoft AJ, Bahat G, Bauer J, Boirie Y, Bruyère O, Cederholm T, Cooper C, Landi F, Rolland Y, Sayer AA, Schneider SM, Sieber CC, Topinkova E, Vandewoude M, Visser M, Zamboni M; Writing Group for the European Working Group on Sarcopenia in Older People 2 (EWGSOP2), and the Extended Group for EWGSOP2. Sarcopenia: revised European consensus on definition and diagnosis. Age Ageing. 2019 Jan 1;48(1):16-31. [CrossRef] [PubMed] [PubMed Central]
16. Chen LK, Woo J, Assantachai P, Auyeung TW, Chou MY, Iijima K, Jang HC, Kang L, Kim M, Kim S, Kojima T, Kuzuya M, Lee JSW, Lee SY, Lee WJ, Lee Y, Liang CK, Lim JY, Lim WS, Peng LN, Sugimoto K, Tanaka T, Won CW, Yamada M, Zhang T, Akishita M, Arai H. Asian Working Group for Sarcopenia: 2019 Consensus Update on Sarcopenia Diagnosis and Treatment. J Am Med Dir Assoc. 2020 Mar;21(3):300-307.e2. [CrossRef] [PubMed]
17. Keilani M, Krall C, Marosi C, Flechl B, Dieckmann K, Widhalm G, Marhold M, Crevenna R. Strength of skeletal muscle and self-reported physical performance in Austrian glioblastoma-patients. Wien Klin Wochenschr. 2012 Jun;124(11-12):377-83. [CrossRef] [PubMed]
18. Beaudart C, McCloskey E, Bruyère O, Cesari M, Rolland Y, Rizzoli R, Araujo de Carvalho I, Amuthavalli Thiyagarajan J, Bautmans I, Bertière MC, Brandi ML, Al-Daghri NM, Burlet N, Cavalier E, Cerreta F, Cherubini A, Fielding R, Gielen E, Landi F, Petermans J, Reginster JY, Visser M, Kanis J, Cooper C. Sarcopenia in daily practice: assessment and management. BMC Geriatr. 2016 Oct 5;16(1):170. [CrossRef] [PubMed] [PubMed Central]
19. Jones K, Gordon-Weeks A, Coleman C, Silva M. Radiologically Determined Sarcopenia Predicts Morbidity and Mortality Following Abdominal Surgery: A Systematic Review and Meta-Analysis. World J Surg. 2017 Sep;41(9):2266-2279. [CrossRef] [PubMed] [PubMed Central]
20. Furtner J, Weller M, Weber M, Gorlia T, Nabors B, Reardon DA, Tonn JC, Stupp R, Preusser M; EORTC Brain Tumor Group. Temporal Muscle Thickness as a Prognostic Marker in Patients with Newly Diagnosed Glioblastoma: Translational Imaging Analysis of the CENTRIC EORTC 26071-22072 and CORE Trials. Clin Cancer Res. 2022 Jan 1;28(1):129-136. [CrossRef] [PubMed]
21. Ranganathan K, Terjimanian M, Lisiecki J, Rinkinen J, Mukkamala A, Brownley C, Buchman SR, Wang SC, Levi B. Temporalis muscle morphomics: the psoas of the craniofacial skeleton. J Surg Res. 2014 Jan;186(1):246-52. [CrossRef] [PubMed]
22. Steindl A, Leitner J, Schwarz M, Nenning KH, Asenbaum U, Mayer S, Woitek R, Weber M, Schöpf V, Berghoff AS, Berger T, Widhalm G, Prayer D, Preusser M, Furtner J. Sarcopenia in Neurological Patients: Standard Values for Temporal Muscle Thickness and Muscle Strength Evaluation. J Clin Med. 2020 Apr 28;9(5):1272. [CrossRef] [PubMed] [PubMed Central]
23. Fearon K, Strasser F, Anker SD, Bosaeus I, Bruera E, Fainsinger RL, Jatoi A, Loprinzi C, MacDonald N, Mantovani G, Davis M, Muscaritoli M, Ottery F, Radbruch L, Ravasco P, Walsh D, Wilcock A, Kaasa S, Baracos VE. Definition and classification of cancer cachexia: an international consensus. Lancet Oncol. 2011 May;12(5):489-95. [CrossRef] [PubMed]
24. Argilés JM, Busquets S, López-Soriano FJ, Costelli P, Penna F. Are there any benefits of exercise training in cancer cachexia? J Cachexia Sarcopenia Muscle. 2012 Jun;3(2):73-6. [CrossRef] [PubMed] [PubMed Central]
25. Di Girolamo FG, Situlin R, Mazzucco S, Valentini R, Toigo G, Biolo G. Omega-3 fatty acids and protein metabolism: enhancement of anabolic interventions for sarcopenia. Curr Opin Clin Nutr Metab Care. 2014 Mar;17(2):145-50. [CrossRef] [PubMed]
26. Padhi D, Higano CS, Shore ND, Sieber P, Rasmussen E, Smith MR. Pharmacological inhibition of myostatin and changes in lean body mass and lower extremity muscle size in patients receiving androgen deprivation therapy for prostate cancer. J Clin Endocrinol Metab. 2014 Oct;99(10):E1967-75. [CrossRef] [PubMed]
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