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Sarcopenic obesity: A probable risk factor for dose limiting toxicity during neo-adjuvant chemotherapy in oesophageal cancer patients.
Clin Nutr. 2016 06; 35(3):724-30.CN

Abstract

BACKGROUND & AIMS

Profound weight loss and malnutrition subsequent to severe dysphagia and cancer cachexia are cardinal symptoms in oesophageal cancer (OC). Low muscle mass/sarcopenia has been linked to toxicity during neo-adjuvant therapy in other cancers, with worser effects in sarcopenic obesity. In this study the association between sarcopenia and/or sarcopenic obesity and dose limiting toxicity (DLT) during cycle one chemotherapy in resectable OC patients was evaluated.

METHODS

Body composition was assessed from computed tomography scans of 72 consecutively diagnosed OC patients. Lean body mass and body fat mass were estimated. Patients were grouped as sarcopenic or non-sarcopenic based on pre-defined gender-specific cut-offs for sarcopenia, and as underweight/normal (BMI < 25) or overweight/obese (BMI ≥ 25). Sarcopenic obesity was defined as sarcopenia combined with overweight and obesity. DLT was defined as temporary reduction/delay or permanent discontinuation of drugs due to adverse effects. Odds ratios for developing toxicity were ascertained using multiple logistic regression.

RESULTS

Of 72 patients, 85% (n = 61) were males. Sarcopenia and sarcopenic obesity were present in 31 (43%) and 10 (14%), respectively, prior to chemotherapy. Sarcopenic patients had significantly lower adipose tissue index (p = 0.02) compared to non-sarcopenic patients. Patients with DLT (n = 24) had lower skeletal muscle mass (p = 0.04) than those without DLT. Sarcopenic patients (OR = 2.47; 95% CI: 0.88-6.93) showed a trend towards increased DLT risk (p < 0.10). Logistic regression with BMI as an interaction term indicated higher DLT risk in sarcopenic patients with normal BMI (OR = 1.60; 95% CI 0.30-8.40), but was non-significant. In the sarcopenic obese, risk of DLT increased significantly (OR = 5.54; 95% CI 1.12-27.44).

CONCLUSIONS

Sarcopenic and sarcopenic obese OC patients may be at a higher risk for developing DLT during chemotherapy compared to non-sarcopenic OC patients.

Authors+Show Affiliations

Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden. Electronic address: poorna.anandavadivelan@ki.se.Department of Clinical Science Intervention and Technology, Karolinska Institutet, Stockholm, Sweden.Department of Clinical Science Intervention and Technology, Karolinska Institutet, Stockholm, Sweden.Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.Department of Biosciences and Nutrition, Karolinska Institutet, Stockholm, Sweden.

Pub Type(s)

Clinical Trial, Phase III
Comparative Study
Journal Article
Multicenter Study
Randomized Controlled Trial

Language

eng

PubMed ID

26065721

Citation

Anandavadivelan, Poorna, et al. "Sarcopenic Obesity: a Probable Risk Factor for Dose Limiting Toxicity During Neo-adjuvant Chemotherapy in Oesophageal Cancer Patients." Clinical Nutrition (Edinburgh, Scotland), vol. 35, no. 3, 2016, pp. 724-30.
Anandavadivelan P, Brismar TB, Nilsson M, et al. Sarcopenic obesity: A probable risk factor for dose limiting toxicity during neo-adjuvant chemotherapy in oesophageal cancer patients. Clin Nutr. 2016;35(3):724-30.
Anandavadivelan, P., Brismar, T. B., Nilsson, M., Johar, A. M., & Martin, L. (2016). Sarcopenic obesity: A probable risk factor for dose limiting toxicity during neo-adjuvant chemotherapy in oesophageal cancer patients. Clinical Nutrition (Edinburgh, Scotland), 35(3), 724-30. https://doi.org/10.1016/j.clnu.2015.05.011
Anandavadivelan P, et al. Sarcopenic Obesity: a Probable Risk Factor for Dose Limiting Toxicity During Neo-adjuvant Chemotherapy in Oesophageal Cancer Patients. Clin Nutr. 2016;35(3):724-30. PubMed PMID: 26065721.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Sarcopenic obesity: A probable risk factor for dose limiting toxicity during neo-adjuvant chemotherapy in oesophageal cancer patients. AU - Anandavadivelan,Poorna, AU - Brismar,Torkel B, AU - Nilsson,Magnus, AU - Johar,Asif M, AU - Martin,Lena, Y1 - 2015/05/27/ PY - 2014/10/06/received PY - 2015/04/23/revised PY - 2015/05/15/accepted PY - 2015/6/13/entrez PY - 2015/6/13/pubmed PY - 2018/1/18/medline KW - Body composition KW - Chemotherapy KW - Oesophageal cancer KW - Sarcopenia KW - Sarcopenic obesity SP - 724 EP - 30 JF - Clinical nutrition (Edinburgh, Scotland) JO - Clin Nutr VL - 35 IS - 3 N2 - BACKGROUND & AIMS: Profound weight loss and malnutrition subsequent to severe dysphagia and cancer cachexia are cardinal symptoms in oesophageal cancer (OC). Low muscle mass/sarcopenia has been linked to toxicity during neo-adjuvant therapy in other cancers, with worser effects in sarcopenic obesity. In this study the association between sarcopenia and/or sarcopenic obesity and dose limiting toxicity (DLT) during cycle one chemotherapy in resectable OC patients was evaluated. METHODS: Body composition was assessed from computed tomography scans of 72 consecutively diagnosed OC patients. Lean body mass and body fat mass were estimated. Patients were grouped as sarcopenic or non-sarcopenic based on pre-defined gender-specific cut-offs for sarcopenia, and as underweight/normal (BMI < 25) or overweight/obese (BMI ≥ 25). Sarcopenic obesity was defined as sarcopenia combined with overweight and obesity. DLT was defined as temporary reduction/delay or permanent discontinuation of drugs due to adverse effects. Odds ratios for developing toxicity were ascertained using multiple logistic regression. RESULTS: Of 72 patients, 85% (n = 61) were males. Sarcopenia and sarcopenic obesity were present in 31 (43%) and 10 (14%), respectively, prior to chemotherapy. Sarcopenic patients had significantly lower adipose tissue index (p = 0.02) compared to non-sarcopenic patients. Patients with DLT (n = 24) had lower skeletal muscle mass (p = 0.04) than those without DLT. Sarcopenic patients (OR = 2.47; 95% CI: 0.88-6.93) showed a trend towards increased DLT risk (p < 0.10). Logistic regression with BMI as an interaction term indicated higher DLT risk in sarcopenic patients with normal BMI (OR = 1.60; 95% CI 0.30-8.40), but was non-significant. In the sarcopenic obese, risk of DLT increased significantly (OR = 5.54; 95% CI 1.12-27.44). CONCLUSIONS: Sarcopenic and sarcopenic obese OC patients may be at a higher risk for developing DLT during chemotherapy compared to non-sarcopenic OC patients. SN - 1532-1983 UR - https://www.unboundmedicine.com/medline/citation/26065721/Sarcopenic_obesity:_A_probable_risk_factor_for_dose_limiting_toxicity_during_neo_adjuvant_chemotherapy_in_oesophageal_cancer_patients_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0261-5614(15)00143-0 DB - PRIME DP - Unbound Medicine ER -