Prognostic value of paravertebral muscle density in patients with spinal metastases from gastrointestinal cancer
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Morphometric analyses have shown that trunk muscle mass and density are associated with mortality in cancer patients. Because of the low incidence of spinal metastasis from gastrointestinal cancer and the limited life expectancy of these patients, few studies have been reported in this population. We evaluated the prognostic value of trunk muscle area and density in predicting overall survival.
The data from 78 patients with spinal metastases from gastrointestinal cancer, collected from February 2009 to July 2016, were evaluated. Psoas muscle and paravertebral muscle area and density were measured at the L3 level on CT scans taken at the time nearest to the diagnosis of spinal metastasis. Cox proportional hazards analysis was performed to evaluate the factors independently associated with overall survival.
The mean patient age was 68.3 years (range, 42–88 years). The overall median survival time was 4.8 months: 2.2 months in the extremely rapid growth group (stomach, biliary tract, and pancreas) and 7.6 months in the rapid growth group (esophagus, liver, and colorectum). Multivariate analyses showed that lower paravertebral muscle density (HR 2.23 [95% CI 1.24–3.99], p = 0.007), extremely rapid growth group, presence of abnormal laboratory data, poor performance status, and chemotherapy after spinal metastasis were independent prognostic factors.
Median overall survival was poor among patients with spinal metastases from gastrointestinal carcinoma, especially among those with gastric, biliary tract, or pancreatic cancer. Lower paravertebral muscle density was an independent poor prognostic factor in patients with spinal metastases from gastrointestinal cancer.
KeywordsSpinal metastasis Gastrointestinal cancer Muscle area Psoas major Sarcopenia Prognosis
We thank Rebecca Tollefson, DVM, from Edanz Group (www.edanzediting.com/ac) for editing a draft of this manuscript.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
- 6.Cruz-Jentoft AJ, Baeyens JP, Bauer JM, Boirie Y, Cederholm T, Landi F, Martin FC, Michel JP, Rolland Y, Schneider SM, Topinkova E, Vandewoude M, Zamboni M (2010) Sarcopenia: European consensus on definition and diagnosis: report of the European working group on sarcopenia in older people. Age Ageing 39:412–423CrossRefGoogle Scholar
- 8.Gakhar H, Dhillon A, Blackwell J, Hussain K, Bommireddy R, Klezl Z, Williams J (2015) Study investigating the role of skeletal muscle mass estimation in metastatic spinal cord compression European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society 24: 2150–2155CrossRefGoogle Scholar
- 12.Ibrahim A, Crockard A, Antonietti P, Boriani S, Bunger C, Gasbarrini A, Grejs A, Harms J, Kawahara N, Mazel C, Melcher R, Tomita K (2008) Does spinal surgery improve the quality of life for those with extradural (spinal) osseous metastases? An international multicenter prospective observational study of 223 patients. Invited submission from the joint section meeting on disorders of the spine and peripheral nerves, march 2007. J Neurosurg Spine 8: 271–278PubMedGoogle Scholar
- 15.Kudou K, Saeki H, Nakashima Y, Sasaki S, Jogo T, Hirose K, Hu Q, Tsuda Y, Kimura K, Nakanishi R, Kubo N, Ando K, Oki E, Ikeda T, Maehara Y (2018) Postoperative development of sarcopenia is a strong predictor of a poor prognosis in patients with adenocarcinoma of the esophagogastric junction and upper gastric cancer. Am J SurgGoogle Scholar
- 16.Margadant CC, Bruns ER, Sloothaak DA, van Duijvendijk P, van Raamt AF, van der Zaag HJ, Buskens CJ, van Munster BC, van der Zaag ES (2016) Lower muscle density is associated with major postoperative complications in older patients after surgery for colorectal cancer. Eur J Surg Oncol 42:1654–1659CrossRefGoogle Scholar
- 20.Nakanishi R, Oki E, Sasaki S, Hirose K, Jogo T, Edahiro K, Korehisa S, Taniguchi D, Kudo K, Kurashige J, Sugiyama M, Nakashima Y, Ohgaki K, Saeki H, Maehara Y (2017) Sarcopenia is an independent predictor of complications after colorectal cancer surgery. Surg TodayGoogle Scholar
- 23.Rief H, Omlor G, Akbar M, Welzel T, Bruckner T, Rieken S, Haefner MF, Schlampp I, Gioules A, Habermehl D, von Nettelbladt F, Debus J (2014) Feasibility of isometric spinal muscle training in patients with bone metastases under radiation therapy - first results of a randomized pilot trial. BMC Cancer 14:67CrossRefGoogle Scholar
- 24.Saeki H, Nakashima Y, Kudou K, Sasaki S, Jogo T, Hirose K, Edahiro K, Korehisa S, Taniguchi D, Nakanishi R, Kubo N, Ando K, Kabashima A, Oki E, Maehara Y (2018) Neoadjuvant chemoradiotherapy for patients with cT3/nearly T4 esophageal cancer: is sarcopenia correlated with postoperative complications and prognosis? World J Surg 42:2894–2901CrossRefGoogle Scholar
- 27.Tancioni F, Navarria P, Pessina F, Attuati L, Mancosu P, Alloisio M, Scorsetti M, Santoro A, Baena RR (2012) Assessment of prognostic factors in patients with metastatic epidural spinal cord compression (MESCC) from solid tumor after surgery plus radiotherapy: a single institution experience European spine journal : official publication of the European spine society, the European spinal deformity society, and the European section of the Cervical Spine Research Society 21. Suppl 1: S146–S148Google Scholar