Association between Computed Tomography-Determined Loss of Muscle Mass and Impaired Three-Month Survival in Frail Older Adults with Cancer
Abstract
:Simple Summary
Abstract
1. Introduction
2. Materials and Methods
2.1. Study Cohort
2.2. Ethics Statement
2.3. Body Composition Analysis
2.4. Clinical Data Acquisition
2.5. Statistical Analyses
3. Results
3.1. Patient Demographics
3.2. Initiated Treatments
3.3. Muscle Index Cut-Offs
3.4. Associations between Low Muscle Mass, Oncological Treatments, and Patient Characteristics
3.5. Three-Month Survival Analyses
3.6. Univariate and Multivariable Analyses for 3-Month Overall Survival in the Non-Curative Treatment Group
3.7. Long-Term Overall Survival
4. Discussion
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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All | Non-Curative | Curative | ||||||
---|---|---|---|---|---|---|---|---|
N = 80 | % | n = 58 | % | n = 22 | % | OR (95% CI) | ||
Age | 75–80 years | 39 | 49 | 28 | 48 | 11 | 50 | 1 |
≥80 years | 41 | 51 | 30 | 52 | 11 | 50 | 0.93 (0.4–2.5) | |
Sex | Female | 37 | 46 | 28 | 48 | 9 | 41 | 1 |
Male | 43 | 54 | 30 | 52 | 13 | 59 | 1.35 (0.5–3.6) | |
Tumor site | Upper GI | 37 | 46 | 30 | 52 | 7 | 32 | 1 |
Lower GI | 26 | 33 | 12 | 21 | 14 | 64 | 5.00 (1.6–15) * | |
Other a | 17 | 21 | 16 | 28 | 1 | 5 | 0.27 (0.0–2.4) | |
Tumor stage | Local | 13 | 16 | 0 | 0 | 13 | 59 | 1 |
Metastatic or locally advanced | 67 | 84 | 58 | 100 | 9 | 41 | N/A | |
ECOG performance status | 0 to 2 | 52 | 65 | 37 | 64 | 15 | 68 | 1 |
3 to 4 | 22 | 28 | 15 | 26 | 7 | 32 | 1.15 (0.4–3.4) | |
Not available | 6 | 8 | 6 | 10 | 0 | 0 | ||
Activities of daily living | Normal | 52 | 65 | 35 | 60 | 17 | 77 | 1 |
Impaired | 24 | 30 | 19 | 33 | 5 | 23 | 0.54 (0.2–1.7) | |
Not available | 4 | 5 | 4 | 7 | 0 | 0 | ||
Clinical frailty scale | 1 to 4 | 48 | 60 | 35 | 60 | 13 | 59 | 1 |
5 to 9 | 26 | 33 | 20 | 35 | 6 | 27 | 0.81 (0.3–2.5) | |
Not available | 6 | 8 | 3 | 5 | 3 | 14 | ||
BMI | ≥22 kg/m2 | 61 | 76 | 42 | 72 | 19 | 86 | 1 |
<22 kg/m2 | 19 | 24 | 16 | 28 | 3 | 14 | 0.41 (0.1–1.6) | |
GLIM b | Normal | 31 | 39 | 19 | 33 | 12 | 55 | 1 |
Malnourishment | 44 | 55 | 34 | 59 | 10 | 46 | 0.47 (0.2–1.39) | |
Not available | 5 | 6 | 5 | 9 | 0 | 0 | ||
Hand-grip strength test | Normal | 48 | 60 | 36 | 62 | 12 | 55 | 1 |
Impaired | 22 | 28 | 13 | 22 | 9 | 41 | 2.08 (0.7–6.1) | |
Not available | 10 | 13 | 9 | 16 | 1 | 5 | ||
Albumin | ≥30 g/L | 41 | 51 | 28 | 48 | 13 | 59 | 1 |
<30 g/L | 17 | 21 | 14 | 24 | 3 | 14 | 0.46 (0.1–1.9) | |
Not available | 22 | 28 | 16 | 28 | 6 | 27 | ||
SMI c | Normal | 33 | 42 | 22 | 38 | 11 | 52 | 1 |
Low | 46 | 58 | 36 | 62 | 10 | 48 | 0.56 (0.2–1.5) | |
PMI c | Normal | 43 | 54 | 33 | 57 | 10 | 46 | 1 |
Low | 37 | 46 | 25 | 43 | 12 | 55 | 1.58 (0.6–4.3) | |
Treatment decision | Oncological treatments | 41 | 51 | 31 | 53 | 10 | 46 | 1 |
Follow-up or BSC d | 39 | 49 | 27 | 47 | 12 | 55 | 1.38 (0.5–3.7) | |
Survival at 3 months | Alive | 66 | 83 | 44 | 76 | 22 | 100 | 1 |
Deceased | 14 | 18 | 14 | 24 | 0 | 0 | N/A |
All Patients | Non-Curative Patients | Univariate | Multivariable a | ||
---|---|---|---|---|---|
Cut-Off | N | n Univariate/n Multivariable | HR 95% CI | HR 95% CI | |
Study SMI (Youden) b | Normal | 33 | 22/22 | 1 | 1 |
Low | 46 | 36/29 | 9.28 (1.2–71) * | 10.65 (1.0–110) * | |
Study SMI (median) c | Normal | 40 | 29/28 | 1 | 1 |
Low | 39 | 29/23 | 2.06 (0.7–6.2) | 2.21 (0.6–8.4) | |
Prado et al. SMI d [12] | Normal | 10 | 7/7 | 1 | 1 |
Low | 69 | 51/44 | 25.21 (0.0–19,000) | N/A | |
Martin et al. SMI e [39] | Normal | 13 | 9/8 | 1 | 1 |
Low | 66 | 49/43 | 1.19 (0.3–5.3) | 1.00 (0.1–8.8) | |
Baracos et al. SMI f [40] | Normal | 10 | 7/7 | 1 | 1 |
Low | 69 | 51/44 | 25.21 (0.0–19,400) | N/A | |
van Vledder et al. SMI g [41] | Normal | 21 | 14/13 | 1 | 1 |
Low | 58 | 44/38 | 0.86 (0.3–2.7) | 1.01 (0.3–4.5) | |
Camus et al. SMI h [42] | Normal | 9 | 7/7 | 1 | 1 |
Low | 70 | 51/44 | 25.21 (0.3–19,000) | N/A | |
Study PMI (Youden) i | Normal | 43 | 33/32 | 1 | 1 |
Low | 37 | 25/18 | 4.10 (1.3–13) * | 2.23 (0.6–8.9) | |
Study PMI (median) j | Normal | 41 | 31/30 | 1 | 1 |
Low | 39 | 27/21 | 4.48 (1.1–11) * | 1.56 (0.4–6.5) | |
Amini et al. PMI k [43] | Normal | 34 | 26/26 | 1 | 1 |
Low | 46 | 32/25 | 3.46 (1.0–12) | 1.84 (0.4–7.7) | |
Joglekar et al. PMI l [44] | Normal | 37 | 28/28 | 1 | 1 |
Low | 43 | 30/23 | 2.74 (0.9–8.7) | 1.31 (0.3–5.2) |
Non-Curative Treatment | Curative Treatment | ||||||
---|---|---|---|---|---|---|---|
Normal SMI | Low SMI a | Normal SMI | Low SMI a | ||||
n = 22 | n = 36 | OR (95% CI) | n = 11 | n = 10 | OR (95% CI) | ||
n (%) | n (%) | n (%) | n (%) | ||||
Age | 75–80 years | 8 (29) | 20 (71) | 1 | 8 (80) | 2 (20) | 1 |
≥80 years | 14 (47) | 16 (53) | 0.46 (0.2–1.4) | 3 (27) | 8 (73) | 10.67 (1.4–82) * | |
Sex | Female | 19 (68) | 9 (32) | 1 | 6 (67) | 3 (33) | 1 |
Male | 3 (10) | 27 (90) | 19.00 (4.5–80) * | 5 (42) | 7 (58) | 2.80 (0.5–17) | |
Tumor site | Upper GI | 8 (27) | 22 (73) | 1 | 4 (57) | 3 (43) | 1 |
Lower GI | 4 (33) | 8 (67) | 0.73 (0.2–3.1) | 7 (54) | 6 (46) | 1.14 (0.2–7.3) | |
Other b | 10 (63) | 6 (38) | 0.22 (0.1–0.8) | 0 (0) | 1 (100) | N/A | |
Tumor stage | Local | 0 (0) | 0 (0) | 1 | 7 (54) | 6 (46) | 1 |
Metastatic or locally advanced | 22 (38) | 36 (62) | N/A | 4 (50) | 4 (50) | 1.17 (0.2–6.8) | |
ECOG performance status | 0 to 2 | 16 (43) | 21 (57) | 1 | 9 (60) | 6 (40) | 1 |
3 to 4 | 6 (40) | 9 (60) | 1.14 (0.3–3.9) | 2 (33) | 4 (67) | 3.00 (0.4–22) | |
Not available | 0 (0) | 6 (100) | 0 (0) | 0 (0) | |||
Activities of daily living | Normal | 14 (40) | 21 (60) | 1 | 8 (50) | 8 (50) | 1 |
Impaired | 7 (37) | 12 (63) | 1.14 (0.4–3.6) | 3 (60) | 2 (40) | 0.67 (0.1–5.1) | |
Not available | 1 (25) | 3 (75) | 0 (0) | 0 (0) | |||
Clinical frailty scale | 1 to 4 | 15 (43) | 20 (57) | 1 | 8 (62) | 5 (39) | 1 |
5 to 9 | 7 (35) | 13 (65) | 1.39 (0.4–4.3) | 2 (40) | 3 (60) | 2.40 (0.3–20) | |
Not available | 0 (0) | 3 (100) | 1 (33) | 2 (67) | |||
BMI | ≥22 kg/m2 | 17 (41) | 25 (60) | 1 | 10 (56) | 8 (44) | 1 |
<22 kg/m2 | 5 (31) | 11 (69) | 1.50 (0.4–5.1) | 1 (33) | 2 (67) | 2.50 (0.2–33) | |
GLIM c | Normal | 11 (58) | 8 (42) | 1 | 6 (55) | 5 (46) | 1 |
Malnourishment | 9 (27) | 25 (74) | 3.82 (1.2–13) * | 5 (50) | 5 (50) | 1.20 (0.2–6.7) | |
Not available | 2 (40) | 3 (60) | 0 (0) | 0 (0) | |||
Hand-grip strength test | Normal | 16 (44) | 20 (56) | 1 | 6 (50) | 6 (50) | 1 |
Impaired | 3 (23) | 10 (77) | 2.67 (0.6–11) | 4 (50) | 4 (50) | 1.00 (0.2–6.0) | |
Not available | 3 (33) | 6 (67) | 1 (100) | 0 (0) | |||
Albumin | ≥30 g/L | 12 (43) | 16 (57) | 1 | 8 (67) | 4 (33) | 1 |
<30 g/L | 2 (14) | 12 (86) | 4.50 (0.8–24) | 1 (33) | 2 (67) | 4.00 (0.3–59) | |
Not available | 8 (50) | 8 (50) | 2 (33) | 4 (67) | |||
Treatment decision | Oncological treatment | 16 (52) | 15 (48) | 1 | 6 (60) | 4 (40) | 1 |
Follow-up or BSC d | 6 (22) | 21 (78) | 3.73 (1.2–12) * | 5 (46) | 6 (55) | 1.80 (0.3–10) | |
Survival at 3 months | Alive | 21 (48) | 23 (52) | 1 | 11 (52) | 10 (48) | 1 |
Deceased | 1 (7) | 13 (93) | 11.87 (1.4–99) * | 0 (0) | 0 (0) | N/A |
Non-Curative Treatment | Curative Treatment | ||||||
---|---|---|---|---|---|---|---|
Normal PMI | Low PMI a | Normal PMI | Low PMI a | ||||
n = 33 | n = 25 | OR (95% CI) | n = 10 | n = 12 | OR (95% CI) | ||
n (%) | n (%) | n (%) | n (%) | ||||
Age | 75–80 years | 16 (57) | 12 (43) | 1 | 5 (46) | 6 (55) | 1 |
≥80 years | 17 (57) | 13 (43) | 1.02 (0.4–2.9) | 5 (46) | 6 (55) | 1.00 (0.2–5.4) | |
Sex | Female | 16 (57) | 12 (43) | 1 | 3 (33) | 6 (67) | 1 |
Male | 17 (57) | 13 (43) | 1.02 (0.4–2.9) | 7 (54) | 6 (46) | 0.43 (0.1–2.5) | |
Tumor site | Upper GI | 18 (60) | 12 (40) | 1 | 1 (14) | 6 (86) | 1 |
Lower GI | 5 (42) | 7 (58) | 2.10 (0.5–8.2) | 8 (57) | 6 (43) | 0.13 (0.0–1.3) | |
Other b | 10 (63) | 6 (38) | 0.9 (0.3–3.1) | 1 (100) | 0 (0) | N/A | |
Tumor stage | Local | 0 (0) | 0 (0) | 1 | 7 (54) | 6 (46) | 1 |
Metastatic or locally advanced | 33 (57) | 25 (43) | N/A | 3 (33) | 6 (67) | 2.33 (0.4–14) | |
ECOG performance status | 0 to 2 | 26 (70) | 11 (30) | 1 | 8(53) | 7 (47) | 1 |
3 to 4 | 6 (40) | 9 (60) | 3.55 (1.0–12) * | 2 (29) | 5 (71) | 2.86 (0.4–20) | |
Not available | 1 (17) | 5 (83) | 0 (0) | 0 (0) | |||
Activities of daily living | Normal | 22 (63) | 13 (37) | 1 | 9 (53) | 8 (47) | 1 |
Impaired | 10 (53) | 9 (47) | 1.52 (0.5–4.7) | 1 (20) | 4 (80) | 4.50 (0.4–49) | |
Not available | 1 (25) | 3 (75) | 0 (0) | 0 (0) | |||
Clinical frailty scale | 1 to 4 | 26 (74) | 9 (26) | 1 | 6 (46) | 7 (54) | 1 |
5 to 9 | 7 (35) | 13 (65) | 5.37 (1.6–18) * | 1 (17) | 5 (83) | 4.29 (0.4–48) | |
Not available | 0 (0) | 3 (100) | 3 (100) | 0 (0) | |||
BMI | ≥22 kg/m2 | 25 (60) | 17 (41) | 1 | 10 (53) | 9 (47) | 1 |
<22 kg/m2 | 8 (50) | 8 (50) | 1.47 (0.5–4.7) | 0 (0) | 3 (100) | N/A | |
GLIM c | Normal | 15 (79) | 4 (21) | 1 | 6 (50) | 6 (50) | 1 |
Malnourishment | 16 (47) | 18 (53) | 4.22 (1.2–15) * | 4 (40) | 6 (60) | 1.50 (0.3–8.2) | |
Not available | 2 (40) | 3 (60) | 0 (0) | 0 (0) | |||
Hand-grip strength | Normal | 26 (72) | 10 (28) | 1 | 4 (33) | 8 (67) | 1 |
Impaired | 4 (31) | 9 (69) | 5.85 (1.5–23) * | 5 (56) | 4 (44) | 0.40 (0.1–2.4) | |
Not available | 3 (33) | 6 (67) | 1 (100) | 0 (0) | |||
Albumin | ≥30 | 19 (68) | 9 (32) | 1 | 7 (54) | 6 (46) | 1 |
<30 | 6 (43) | 8 (57) | 2.82 (0.8–11) | 0 (0) | 3 (100) | N/A | |
Not available | 8 (50) | 8 (50) | 3 (50) | 3 (50) | |||
Treatment decision | Oncological treatment | 23 (74) | 8 (26) | 1 | 3 (30) | 7 (70) | 1 |
Follow-up or BSC d | 10 (37) | 17 (63) | 4.89 (1.6–15) * | 7 (58) | 5 (42) | 0.31 (0.1–1.8) | |
Survival at 3 months | Alive | 29 (66) | 15 (34) | 1 | 10 (46) | 12 (55) | 1 |
Deceased | 4 (29) | 10 (71) | 4.83 (1.3–18) * | 0 (0) | 0 (0) | N/A |
SMI | PMI | ||||
---|---|---|---|---|---|
Patient n | Univariate | Multivariable | Univariate | Multivariable | |
Univariate/Multivariable | HR (95% CI) | HR (95% CI) | HR (95% CI) | HR (95% CI) | |
Muscle mass | |||||
Normal | SMI 22/22; PMI 33/32 | 1 | 1 | 1 | 1 |
Low a | SMI 36/29; PMI 25/18 | 9.28 (1.2–71) * | 10.65 (1.0–110) * | 4.10 (1.3–13) * | 2.23 (0.6–8.9) |
Sex | |||||
Women | 28/25 | 1 | 1 | 1 | 1 |
Men | 30/26 | 1.68 (0.6–5.0) | 0.57 (0.1–2.8) | 1.68 (0.6–5.0) | 2.1 (0.5–8.1) |
ECOG PS | |||||
0 to 2 | 37/36 | 1 | 1 | 1 | 1 |
3 to 4 | 15/15 | 3.01 (0.9–10) | 2.34 (0.6–9.8) | 3.01 (0.9–10) | 1.80 (0.4–7.2) |
Clinical frailty scale | |||||
1 to 4 | 35/33 | 1 | 1 | 1 | 1 |
5 to 9 | 20/18 | 3.35 (1.1–10) * | 2.11 (0.5–8.6) | 3.35 (1.1–10) * | 1.66 (0.4–7.6) |
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Tolonen, A.; Kerminen, H.; Lehtomäki, K.; Huhtala, H.; Bärlund, M.; Österlund, P.; Arponen, O. Association between Computed Tomography-Determined Loss of Muscle Mass and Impaired Three-Month Survival in Frail Older Adults with Cancer. Cancers 2023, 15, 3398. https://doi.org/10.3390/cancers15133398
Tolonen A, Kerminen H, Lehtomäki K, Huhtala H, Bärlund M, Österlund P, Arponen O. Association between Computed Tomography-Determined Loss of Muscle Mass and Impaired Three-Month Survival in Frail Older Adults with Cancer. Cancers. 2023; 15(13):3398. https://doi.org/10.3390/cancers15133398
Chicago/Turabian StyleTolonen, Antti, Hanna Kerminen, Kaisa Lehtomäki, Heini Huhtala, Maarit Bärlund, Pia Österlund, and Otso Arponen. 2023. "Association between Computed Tomography-Determined Loss of Muscle Mass and Impaired Three-Month Survival in Frail Older Adults with Cancer" Cancers 15, no. 13: 3398. https://doi.org/10.3390/cancers15133398