Abstract
Purpose
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.
Methods
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.
Results
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.
Conclusions
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.
Similar content being viewed by others
References
Bauer H, Tomita K, Kawahara N, Abdel-Wanis ME, Murakami H (2002) Surgical strategy for spinal metastases. Spine 27:1124–1126
Blauwhoff-Buskermolen S, Versteeg KS, de van der Schueren MA, den Braver NR, Berkhof J, Langius JA, Verheul HM (2016) Loss of muscle mass during chemotherapy is predictive for poor survival of patients with metastatic colorectal cancer. J Clin Oncol 34:1339–1344
Boer BC, de Graaff F, Brusse-Keizer M, Bouman DE, Slump CH, Slee-Valentijn M, Klaase JM (2016) Skeletal muscle mass and quality as risk factors for postoperative outcome after open colon resection for cancer. Int J Color Dis 31:1117–1124
Borad MJ, Saadati H, Lakshmipathy A, Campbell E, Hopper P, Jameson G, Von Hoff DD, Saif MW (2009) Skeletal metastases in pancreatic cancer: a retrospective study and review of the literature. Yale J Biol Med 82:1–6
Constans JP, de Divitiis E, Donzelli R, Spaziante R, Meder JF, Haye C (1983) Spinal metastases with neurological manifestations. Review of 600 cases. J Neurosurg 59: 111–118
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 39:412–423
Dowsiriroj P, Paholpak P, Sirichativapee W, Wisanuyotin T, Laupattarakasem P, Sukhonthamarn K, Kosuwon W, Jeeravipoolvarn P (2017) Cholangiocarcinoma with spinal metastasis: single center survival analysis. J Clin Neurosci 38:43–48
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: 2150–2155
Goodwin CR, Abu-Bonsrah N, Boone C, Ruiz-Valls A, Sankey EW, Sarabia-Estrada R, Elder BD, Kosztowski T, Sciubba DM (2016) Non-hepatocellular carcinoma spinal metastases. J Clin Neurosci 27:22–27
Hanaoka M, Yasuno M, Ishiguro M, Yamauchi S, Kikuchi A, Tokura M, Ishikawa T, Nakatani E, Uetake H (2017) Morphologic change of the psoas muscle as a surrogate marker of sarcopenia and predictor of complications after colorectal cancer surgery. Int J Color Dis 32:847–856
Hatrick NC, Lucas JD, Timothy AR, Smith MA (2000) The surgical treatment of metastatic disease of the spine. Radiother Oncol 56:335–339
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: 271–278
Jacobs WB, Perrin RG (2001) Evaluation and treatment of spinal metastases: an overview. Neurosurg Focus 11:e10
Katagiri H, Okada R, Takagi T, Takahashi M, Murata H, Harada H, Nishimura T, Asakura H, Ogawa H (2014) New prognostic factors and scoring system for patients with skeletal metastasis. Cancer Med 3:1359–1367
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 Surg
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 42:1654–1659
Mitsiopoulos N, Baumgartner RN, Heymsfield SB, Lyons W, Gallagher D, Ross R (1998) Cadaver validation of skeletal muscle measurement by magnetic resonance imaging and computerized tomography. J Appl Physiol (1985) 85: 115–122
Mourtzakis M, Prado CM, Lieffers JR, Reiman T, McCargar LJ, Baracos VE (2008) A practical and precise approach to quantification of body composition in cancer patients using computed tomography images acquired during routine care. Appl Physiol Nutr Metab 33:997–1006
Nagata T, Nakase Y, Nakamura K, Sougawa A, Mochiduki S, Kitai S, Inaba S (2016) Prognostic impact of a nutritional index including muscle volume in stage 4 colorectal cancer. In Vivo 30:885–891
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 Today
Prado CM, Lieffers JR, McCargar LJ, Reiman T, Sawyer MB, Martin L, Baracos VE (2008) Prevalence and clinical implications of sarcopenic obesity in patients with solid tumours of the respiratory and gastrointestinal tracts: a population-based study. Lancet Oncol 9:629–635
Rades D, Dunst J, Schild SE (2008) The first score predicting overall survival in patients with metastatic spinal cord compression. Cancer 112:157–161
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 14:67
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 42:2894–2901
Shen W, Punyanitya M, Wang Z, Gallagher D, St-Onge MP, Albu J, Heymsfield SB, Heshka S (2004) Total body skeletal muscle and adipose tissue volumes: estimation from a single abdominal cross-sectional image. J Appl Physiol 97(1985):2333–2338
Sun G, Li Y, Peng Y, Lu D, Zhang F, Cui X, Zhang Q, Li Z (2018) Can sarcopenia be a predictor of prognosis for patients with non-metastatic colorectal cancer? A systematic review and meta-analysis. Int J Color Dis 33:1419–1427
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–S148
Tang V, Harvey D, Park Dorsay J, Jiang S, Rathbone MP (2007) Prognostic indicators in metastatic spinal cord compression: using functional independence measure and Tokuhashi scale to optimize rehabilitation planning. Spinal Cord 45:671–677
Tokuhashi Y, Matsuzaki H, Oda H, Oshima M, Ryu J (2005) A revised scoring system for preoperative evaluation of metastatic spine tumor prognosis. Spine 30:2186–2191
Tomita K, Kawahara N, Kobayashi T, Yoshida A, Murakami H, Akamaru T (2001) Surgical strategy for spinal metastases. Spine 26:298–306
van der Linden YM, Dijkstra SP, Vonk EJ, Marijnen CA, Leer JW (2005) Prediction of survival in patients with metastases in the spinal column: results based on a randomized trial of radiotherapy. Cancer 103:320–328
van Vledder MG, Levolger S, Ayez N, Verhoef C, Tran TC, Ijzermans JN (2012) Body composition and outcome in patients undergoing resection of colorectal liver metastases. Br J Surg 99:550–557
Zakaria HM, Basheer A, Boyce-Fappiano D, Elibe E, Schultz L, Lee I, Siddiqui F, Griffith B, Chang V (2016) Application of morphometric analysis to patients with lung cancer metastasis to the spine: a clinical study. Neurosurg Focus 41:E12
Acknowledgment
We thank Rebecca Tollefson, DVM, from Edanz Group (www.edanzediting.com/ac) for editing a draft of this manuscript.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors declare that they have no conflict of interest.
Rights and permissions
About this article
Cite this article
Dohzono, S., Sasaoka, R., Takamatsu, K. et al. Prognostic value of paravertebral muscle density in patients with spinal metastases from gastrointestinal cancer. Support Care Cancer 27, 1207–1213 (2019). https://doi.org/10.1007/s00520-018-4465-x
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00520-018-4465-x