Fat-free muscle area measured by magnetic resonance imaging predicts overall survival of patients undergoing radioembolization of colorectal cancer liver metastases
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To investigate the clinical potential of fat-free muscle area (FFMA) to predict outcome in patients with liver-predominant metastatic colorectal cancer (mCRC) undergoing radioembolization (RE) with 90Yttrium microspheres.
Patients with mCRC who underwent RE in our center were included in this retrospective study. All patients received liver magnetic resonance imaging including standard T2-weighted images. The total erector spinae muscle area and the intramuscular adipose tissue area were measured at the level of the origin of the superior mesenteric artery and subtracted to calculate FFMA. Cutoff values for definition of low FFMA were 3644 mm2 in men and 2825 mm2 in women. The main outcome was overall survival (OS). For survival analysis, the Kaplan-Meier method and Cox regressions comparing various clinic-oncological parameters which potentially may affect OS were performed.
Seventy-seven patients (28 female, mean age 60 ± 11 years) were analyzed. Mean time between MRI and the following RE was 17 ± 31 days. Median OS after RE was 178 days. Patients with low FFMA had significantly shortened OS compared to patients with high FFMA (median OS: 128 vs. 273 days, p = 0.017). On multivariate Cox regression analysis, OS was best predicted by FFMA (hazard ratio (HR) 2.652; p < 0.001). Baseline bilirubin (HR 1.875; p = 0.030), pattern of tumor manifestation (HR 1.679; p = 0.001), and model of endstage liver disease (MELD) score (HR 1.164; p < 0.001) were also significantly associated with OS.
FFMA was associated with OS in patients receiving RE for treatment of mCRC and might be a new prognostic biomarker for survival prognosis.
• Fat-free muscle area (FFMA) as a measure of lean muscle area predicts survival in metastatic colorectal liver cancer following radioembolization.
• FFMA can easily be assessed from routine pre-interventional liver magnetic resonance imaging.
• FFMA might be a new promising biomarker for assessment of sarcopenia.
KeywordsSarcopenia Colorectal cancer Brachytherapy Magnetic resonance imaging
Adipose tissue area
Eastern Cooperative Oncology Group performance status
Fat-free muscle area
Liver-predominant metastatic colorectal cancer
Model of endstage liver disease
Magnetic resonance imaging
Proton density fat fraction
Skeletal muscle index
Transjugular intrahepatic portosystemic shunt
Total muscle area
The authors state that this work has not received any funding.
Compliance with ethical standards
The scientific guarantor of this publication is PD Dr. Julian A. Luetkens.
Conflict of interest
The authors of this manuscript declare relationships with the following companies: C.M. is a consultant for SIRTEX Medical; C.C.P. received speakers’ fees from Philips Healthcare.
Statistics and biometry
One of the authors (R.F.) has significant statistical expertise.
Written informed consent was waived by the Institutional Review Board.
Institutional Review Board approval was obtained.
• prognostic study
• performed at one institution
- 4.Garden OJ, Rees M, Poston GJ et al (2006) Guidelines for resection of colorectal cancer liver metastases. Gut 55(Suppl 3):1–8Google Scholar
- 8.Chang KV, Chen JD, Wu WT, Huang KC, Hsu CT, Han DS (2017) Association between loss of skeletal muscle mass and mortality and tumor recurrence in hepatocellular carcinoma: a systematic review and meta-analysis. Liver Cancer 87:90–103Google Scholar
- 22.Lewandowski RJ, Thurston KG, Goin JE et al (2005) 90Y microsphere (TheraSphere) treatment for unresectable colorectal cancer metastases of the liver: response to treatment at targeted doses of 135-150 Gy as measured by [18F]fluorodeoxyglucose positron emission tomography and computed tomographic imaging. J Vasc Interv Radiol 16:1641–1651CrossRefGoogle Scholar
- 23.Peng PD, van Vledder MG, Tsai S et al (2011) Sarcopenia negatively impacts short-term outcomes in patients undergoing hepatic resection for colorectal liver metastasis. HPB (Oxford) 13:439–446Google Scholar
- 29.Grimm A, Meyer H, Nickel MD et al (2018) A comparison between 6-point DIXON MRI and MR spectroscopy to quantify muscle fat in the thigh of subjects with sarcopenia. J Frailty Aging. https://doi.org/10.14283/jfa.2018.16
- 30.Schlaeger S, Inhuber S, Rohrmeier A et al (2018) Association of paraspinal muscle water–fat MRI-based measurements with isometric strength measurements. Eur Radiol. https://doi.org/10.1007/s00330-018-5631-8
- 31.Wasan HS, Gibbs P, Sharma NK et al (2017) First-line selective internal radiotherapy plus chemotherapy versus chemotherapy alone in patients with liver metastases from colorectal cancer (FOXFIRE, SIRFLOX, and FOXFIRE-global): a combined analysis of three multicentre, randomised, phase 3 trials. Lancet Oncol 18:1159–1171CrossRefGoogle Scholar
- 32.van Hazel GA, Heinemann V, Sharma NK et al (2016) SIRFLOX: randomized phase III trial comparing first-line mFOLFOX6 (plus or minus bevacizumab) versus mFOLFOX6 (plus or minus bevacizumab) plus selective internal radiation therapy in patients with metastatic colorectal cancer. J Clin Oncol 34:1723–1731CrossRefGoogle Scholar