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Clinical implications of low skeletal muscle mass in early-stage breast and colorectal cancer

  • Elizabeth Cespedes Feliciano (a1) and Wendy Y. Chen (a2) (a3)

Abstract

Although obesity has now been widely accepted to be an important risk factor for cancer survival, the associations between BMI and cancer mortality have not been consistently linear. Although morbid obesity has clearly been associated with worse survival, some studies have suggested a U-shaped association with no adverse association with overweight or lower levels of obesity. This ‘obesity paradox’ may be due to the fact that BMI likely incompletely captures key measures of body composition, including distribution of skeletal muscle and adipose tissue. Fat and lean body mass can be measured using clinically acquired computed tomography scans. Many of the earlier studies focused on patients with metastatic cancer. However, skeletal muscle loss in the metastatic setting may reflect end-stage disease processes. Therefore, this article focuses on the clinical implication of low skeletal muscle mass in early-stage non-metastatic breast and colorectal cancer where measures of body composition have been shown to be strong predictors of disease-free survival and overall survival and also chemotherapy toxicity and operative risk.

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Corresponding author

*Corresponding author: W. Y. Chen, email Wendy_Chen@dfci.harvard.edu

References

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1.Ligibel, JA, Alfano, CM, Courneya, KS et al. (2014) American society of clinical oncology position statement on obesity and cancer. J Clin Oncol 31, 35683574.
2.Caan, BJ, Meyerhardt, JA, Kroenke, CH et al. (2017) Explaining the obesity paradox: the association between body composition and colorectal cancer survival (C-SCANS study). Cancer Epidemiol Biomark Prev 26, 10081015.
3.Fearon, K, Strasser, F, Anker, SD et al. (2011) Definition and classification of cancer cachexia: an international consensus. Lancet Oncol 12, 489495.
4.Shen, W, Punyanitya, M, Wang, Z et al. (2004) Total body skeletal muscle and adipose tissue volumes: estimation from a single abdominal cross-sectional image. J Appl Physiol 97, 23332338.
5.Pratesi, A, Tarantini, F & Di Bari, M (2013) Skeletal muscle: an endocrine organ. Clin Cases Miner Bone Metab 10, 1114.
6.Bekkelund, SI & Jorde, R (2017) Lean body mass and creatine kinase is associated with reduced inflammation in obesity. Eur J Clin Invest 47, 803811.
7.Kalinkovich, A & Livshits, G (2016) Sarcopenic obesity or obese sarcopenia: a cross talk between age-associated adipose tissue and skeletal muscle inflammation as a main mechanism of the pathogenesis. Ageing Res Rev 35, 200221.
8.Feliciano, EMC, Kroenke, CH, Meyerhardt, JA et al. (2017) Association of systemic inflammation and sarcopenia with survival in nonmetastatic colorectal cancer: results from the C SCANS study. JAMA Oncol 3, e172319.
9.Malietzis, G, Johns, N, Al-Hassi, HO et al. (2016) Low muscularity and myosteatosis is related to the host systemic inflammatory response in patients undergoing surgery for colorectal cancer. Ann Surg 263, 320325.
10.Pedersen, L, Idorn, M, Olofsson, GH et al. (2016) Voluntary running suppresses tumor growth through epinephrine-and IL-6-dependent NK cell mobilization and redistribution. Cell Metab 23, 554562.
11.Argiles, JM, Busquets, S, Stemmler, B et al. (2015) Cachexia and sarcopenia: mechanisms and potential targets for intervention. Curr Opin Pharmacol 22, 100106.
12.Srikanthan, P, Hevener, AL & Karlamangla, AS. (2010) Sarcopenia exacerbates obesity-associated insulin resistance and dysglycemia: findings from the National Health and Nutrition Examination Survey III. PLoS ONE 5, e10805.
13.Prado, CM, Lieffers, JR, McCargar, LJ et al. (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, 629635.
15.Siegel, RL, Miller, KD & Jemal, A (2018) Cancer statistics, 2018. CA Cancer J Clin 68, 730.
16.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, 439446.
17.Broughman, JR, Williams, GR, Deal, AM et al. (2015) Prevalence of sarcopenia in older patients with colorectal cancer. J Geriatr Oncol 6, 442445.
18.Shachar, SS, Williams, GR, Muss, HB et al. (2016) Prognostic value of sarcopenia in adults with solid tumours: a meta-analysis and systematic review. Eur J Cancer 57, 5867.
19.Malietzis, G, Currie, AC, Athanasiou, T et al. (2016) Influence of body composition profile on outcomes following colorectal cancer surgery. Br J Surg 103, 572580.
20.Joglekar, S, Nau, PN & Mezhir, JJ (2015) The impact of sarcopenia on survival and complications in surgical oncology: a review of the current literature. J Surg Oncol 112, 503509.
21.Mei, KL, Batsis, JA, Mills, JB et al. (2016) Sarcopenia and sarcopenic obesity: do they predict inferior oncologic outcomes after gastrointestinal cancer surgery? Perioper Med 5, 30.
22.Wagner, D, DeMarco, MM, Amini, N et al. (2016) Role of frailty and sarcopenia in predicting outcomes among patients undergoing gastrointestinal surgery. World J Gastrointest Surg 8, 2740.
23.Lieffers, JR, Bathe, OF, Fassbender, K et al. (2012) Sarcopenia is associated with postoperative infection and delayed recovery from colorectal cancer resection surgery. Br J Cancer 107, 931936.
24.Vega, MC, Laviano, A & Pimentel, GD (2016) Sarcopenia and chemotherapy-mediated toxicity. Einstein (Sao Paulo, Brazil) 14, 580584.
25.Prado, CM, Baracos, VE, McCargar, LJ et al. (2007) Body composition as an independent determinant of 5-fluorouracil-based chemotherapy toxicity. Clin Cancer Res 13, 32643268.
26.Jung, HW, Kim, JW, Kim, JY et al. (2015) Effect of muscle mass on toxicity and survival in patients with colon cancer undergoing adjuvant chemotherapy. Support Care Cancer 23, 687694.
27.Ali, R, Baracos, VE, Sawyer, MB et al. (2016) Lean body mass as an independent determinant of dose-limiting toxicity and neuropathy in patients with colon cancer treated with FOLFOX regimens. Cancer Med 5, 607616.
28.Barret, M, Antoun, S, Dalban, C et al. (2014) Sarcopenia is linked to treatment toxicity in patients with metastatic colorectal cancer. Nutr Cancer 66, 583589.
29.Chemama, S, Bayar, MA, Lanoy, E et al. (2016) Sarcopenia is associated with chemotherapy toxicity in patients undergoing cytoreductive surgery with hyperthermic intraperitoneal chemotherapy for peritoneal carcinomatosis from colorectal cancer. Ann Surg Oncol 23, 38913898.
30.Cespedes Feliciano, EM, Lee, VS, Prado, CM et al. (2017) Muscle mass at the time of diagnosis of nonmetastatic colon cancer and early discontinuation of chemotherapy, delays, and dose reductions on adjuvant FOLFOX: the C-SCANS study. Cancer 123, 48684877.
31.McLeay, SC, Morrish, GA, Kirkpatrick, CM et al. (2012) The relationship between drug clearance and body size: systematic review and meta-analysis of the literature published from 2000 to 2007. Clin Pharmacokinet 51, 319330.
32.Williams, GR, Deal, AM, Shachar, SS et al. (2018) The impact of skeletal muscle on the pharmacokinetics and toxicity of 5-fluorouracil in colorectal cancer. Cancer Chemother Pharmacol 81, 413417.
33.Kwan, ML, Chen, WY, Kroenke, CH et al. (2012) Pre-diagnosis body mass index and survival after breast cancer in the after breast cancer pooling project. Breast Cancer Res Treat 132, 729739.
34.Chan, DS, Vieira, AR, Aune, D et al. (2014) Body mass index and survival in women with breast cancer-systematic literature review and meta-analysis of 82 follow-up studies. Ann Oncol 25, 19011914.
35.Greenlee, H, Unger, JM, LeBlanc, M et al. (2017) Association between body mass index (BMI) and cancer survival in a pooled analysis of 22 clinical trials. Cancer Epidemiol Biomark Prev 26, 2129.
36.Caan, BJ, Cespedes-Feliciano, EM, Prado, CM et al. (2018) Adiposity and muscle measured on computed tomography scans are associated with survival among non-metastatic breast cancer patients. JAMA Oncol [Epublication ahead of print version].
37.Villasenor, A, Ballard-Barbash, R, Baumgartner, K et al. (2012) Prevalence and prognostic effect of sarcopenia in breast cancer survivors: the HEAL Study. J Cancer Surviv 6, 398406.
38.Del Fabbro, E, Parsons, H, Warneke, CL et al. (2012) The relationship between body composition and response to neoadjuvant chemotherapy in women with operable breast cancer. Oncologist 17, 12401245.
39.Deluche, E, Leobon, S, Desport, JC et al. (2018) Impact of body composition on outcome in patients with early breast cancer. Support Care Cancer 26, 861868.
40.Shachar, SS, Deal, AM, Weinberg, M et al. (2017) Body composition as a predictor of toxicity in patients receiving anthracycline and taxane based chemotherapy for early stage breast cancer. Clin Cancer Res 23, 35373543.
41.Wong, AL, Seng, KY, Ong, EM et al. (2014) Body fat composition impact the hematologic and pharmacokinetics of doxorubicin in Asian breast cancer patients. Breast Cancer Res Treat 144, 143152.
42.Prado, CM, Lima, IS, Baracos, VE et al. (2011) An exploratory study of body composition as a determinant of epirubicin pharmacokinetics and toxicity. Cancer Chemother Pharmacol 67, 93101.
43.Adams, SC, Segal, RJ, McKenzie, DC et al. (2016) Impact of resistance and aerobic exercise on sarcopenia and dynpaenia in breast cancer patients receiving adjuvant chemotherapy; a multicenter randomized controlled trial. Breast Cancer Res Treat 158, 497507.
44.Thomas, GA, Cartmel, B, Harrigan, M et al. (2017) The effect of exercise on body composition and bone mineral density in breast cancer survivors taking aromatase inhibitors. Obesity 25, 346351.
45.Deili-Conwright, CM, Parmentier, JH, Sami, M (2018) et al. Adipose tissue inflammation in breast cancer survivors: effects of a 16 week combined aerobic and resistance exercise training intervention. Breast Cancer Res Treat 168, 147157.

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