Low Muscularity and Myosteatosis Is Related to the Host Systemic Inflammatory Response in Patients Undergoing Surgery for Colorectal Cancer

George Malietzis; Neil Johns; Hafid O Al-Hassi; Stella C Knight; Robin H Kennedy; Kenneth C H Fearon; Omer Aziz; John T Jenkins

doi:10.1097/SLA.0000000000001113

Low Muscularity and Myosteatosis Is Related to the Host Systemic Inflammatory Response in Patients Undergoing Surgery for Colorectal Cancer

George Malietzis, Neil Johns, Hafid O Al-Hassi, Stella C Knight, Robin H Kennedy, Kenneth C H Fearon, Omer Aziz, John T Jenkins

Research output: Contribution to journal › Article › peer-review

Abstract

OBJECTIVE: We examined the relationships between computed tomography (CT)-defined skeletal muscle parameters and the systemic inflammatory response (SIR) in patients with operable primary colorectal cancer (CRC).

BACKGROUND: Muscle depletion is characterized by a reduced muscle mass (myopenia) and increased infiltration by inter- and intramuscular fat (myosteatosis). It is recognized as a poor prognostic indicator in patients with cancer, but the underlying factors remain unclear.

METHODS: A total of 763 patients diagnosed with CRC undergoing elective surgical resection between 2006 and 2013 were included. Image analysis of CT scans was used to calculate Lumbar skeletal muscle index (LSMI), and mean muscle attenuation (MA). The SIR was quantified by the preoperative neutrophil to lymphocyte ratio (NLR) and albumin levels. Correlation and multivariate regression analysis was performed to identify independent relationships between patient SIR and muscle characteristics.

RESULTS: Patients with NLR > 3 had significantly lower LSMI and lower MA than those with NLR < 3 [LSMI = 42.07 cmm vs 44.27 cmm (P = 0.002) and MA = 30.04 Hounsfield unit (HU) vs 28.36 HU (P = 0.016)]. Multivariate logistic regression analysis showed that high NLR [odds ratio (OR) = 1.78 (95% confidence interval [CI]: 1.29-2.45), P < 0.001] and low albumin [OR = 1.80 (95% CI: 1.17-2.74), P = 0.007] were independent predictors of reduced muscle mass. High NLR was significantly related with a low mean MA and hence myosteatosis [OR = 1.60 (95% CI: 1.03-2.49), P = 0.038].

CONCLUSIONS: These results highlight a direct association between myopenia, myosteatosis, and the host SIR in patients with operable CRC. A better understanding of factors that regulate muscle changes such as myopenia and myosteatosis may lead to the development of novel therapies that influence a more metabolically "healthy" skeletal muscle and potentially alter cancer outcomes.

Original language	English
Pages (from-to)	320-5
Number of pages	6
Journal	Annals of surgery
Volume	263
Issue number	2
DOIs	https://doi.org/10.1097/SLA.0000000000001113
Publication status	Published - 1 Feb 2016

Keywords

Adult
Aged
Aged, 80 and over
Body Composition
Colorectal Neoplasms/complications
Elective Surgical Procedures
Female
Humans
Male
Middle Aged
Multivariate Analysis
Muscle, Skeletal/diagnostic imaging
Muscular Diseases/diagnostic imaging
Prognosis
Systemic Inflammatory Response Syndrome/etiology
Tomography, X-Ray Computed

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1097/SLA.0000000000001113

Cite this

@article{3c698fc5ecf1427cb891c356f50f749e,

title = "Low Muscularity and Myosteatosis Is Related to the Host Systemic Inflammatory Response in Patients Undergoing Surgery for Colorectal Cancer",

abstract = "OBJECTIVE: We examined the relationships between computed tomography (CT)-defined skeletal muscle parameters and the systemic inflammatory response (SIR) in patients with operable primary colorectal cancer (CRC).BACKGROUND: Muscle depletion is characterized by a reduced muscle mass (myopenia) and increased infiltration by inter- and intramuscular fat (myosteatosis). It is recognized as a poor prognostic indicator in patients with cancer, but the underlying factors remain unclear.METHODS: A total of 763 patients diagnosed with CRC undergoing elective surgical resection between 2006 and 2013 were included. Image analysis of CT scans was used to calculate Lumbar skeletal muscle index (LSMI), and mean muscle attenuation (MA). The SIR was quantified by the preoperative neutrophil to lymphocyte ratio (NLR) and albumin levels. Correlation and multivariate regression analysis was performed to identify independent relationships between patient SIR and muscle characteristics.RESULTS: Patients with NLR > 3 had significantly lower LSMI and lower MA than those with NLR < 3 [LSMI = 42.07 cmm vs 44.27 cmm (P = 0.002) and MA = 30.04 Hounsfield unit (HU) vs 28.36 HU (P = 0.016)]. Multivariate logistic regression analysis showed that high NLR [odds ratio (OR) = 1.78 (95% confidence interval [CI]: 1.29-2.45), P < 0.001] and low albumin [OR = 1.80 (95% CI: 1.17-2.74), P = 0.007] were independent predictors of reduced muscle mass. High NLR was significantly related with a low mean MA and hence myosteatosis [OR = 1.60 (95% CI: 1.03-2.49), P = 0.038].CONCLUSIONS: These results highlight a direct association between myopenia, myosteatosis, and the host SIR in patients with operable CRC. A better understanding of factors that regulate muscle changes such as myopenia and myosteatosis may lead to the development of novel therapies that influence a more metabolically {"}healthy{"} skeletal muscle and potentially alter cancer outcomes.",

keywords = "Adult, Aged, Aged, 80 and over, Body Composition, Colorectal Neoplasms/complications, Elective Surgical Procedures, Female, Humans, Male, Middle Aged, Multivariate Analysis, Muscle, Skeletal/diagnostic imaging, Muscular Diseases/diagnostic imaging, Prognosis, Systemic Inflammatory Response Syndrome/etiology, Tomography, X-Ray Computed",

author = "George Malietzis and Neil Johns and Al-Hassi, {Hafid O} and Knight, {Stella C} and Kennedy, {Robin H} and Fearon, {Kenneth C H} and Omer Aziz and Jenkins, {John T}",

year = "2016",

month = feb,

day = "1",

doi = "10.1097/SLA.0000000000001113",

language = "English",

volume = "263",

pages = "320--5",

journal = "Annals of surgery",

issn = "0003-4932",

publisher = "Lippincott Williams & Wilkins",

number = "2",

}

TY - JOUR

T1 - Low Muscularity and Myosteatosis Is Related to the Host Systemic Inflammatory Response in Patients Undergoing Surgery for Colorectal Cancer

AU - Malietzis, George

AU - Johns, Neil

AU - Al-Hassi, Hafid O

AU - Knight, Stella C

AU - Kennedy, Robin H

AU - Fearon, Kenneth C H

AU - Aziz, Omer

AU - Jenkins, John T

PY - 2016/2/1

Y1 - 2016/2/1

N2 - OBJECTIVE: We examined the relationships between computed tomography (CT)-defined skeletal muscle parameters and the systemic inflammatory response (SIR) in patients with operable primary colorectal cancer (CRC).BACKGROUND: Muscle depletion is characterized by a reduced muscle mass (myopenia) and increased infiltration by inter- and intramuscular fat (myosteatosis). It is recognized as a poor prognostic indicator in patients with cancer, but the underlying factors remain unclear.METHODS: A total of 763 patients diagnosed with CRC undergoing elective surgical resection between 2006 and 2013 were included. Image analysis of CT scans was used to calculate Lumbar skeletal muscle index (LSMI), and mean muscle attenuation (MA). The SIR was quantified by the preoperative neutrophil to lymphocyte ratio (NLR) and albumin levels. Correlation and multivariate regression analysis was performed to identify independent relationships between patient SIR and muscle characteristics.RESULTS: Patients with NLR > 3 had significantly lower LSMI and lower MA than those with NLR < 3 [LSMI = 42.07 cmm vs 44.27 cmm (P = 0.002) and MA = 30.04 Hounsfield unit (HU) vs 28.36 HU (P = 0.016)]. Multivariate logistic regression analysis showed that high NLR [odds ratio (OR) = 1.78 (95% confidence interval [CI]: 1.29-2.45), P < 0.001] and low albumin [OR = 1.80 (95% CI: 1.17-2.74), P = 0.007] were independent predictors of reduced muscle mass. High NLR was significantly related with a low mean MA and hence myosteatosis [OR = 1.60 (95% CI: 1.03-2.49), P = 0.038].CONCLUSIONS: These results highlight a direct association between myopenia, myosteatosis, and the host SIR in patients with operable CRC. A better understanding of factors that regulate muscle changes such as myopenia and myosteatosis may lead to the development of novel therapies that influence a more metabolically "healthy" skeletal muscle and potentially alter cancer outcomes.

AB - OBJECTIVE: We examined the relationships between computed tomography (CT)-defined skeletal muscle parameters and the systemic inflammatory response (SIR) in patients with operable primary colorectal cancer (CRC).BACKGROUND: Muscle depletion is characterized by a reduced muscle mass (myopenia) and increased infiltration by inter- and intramuscular fat (myosteatosis). It is recognized as a poor prognostic indicator in patients with cancer, but the underlying factors remain unclear.METHODS: A total of 763 patients diagnosed with CRC undergoing elective surgical resection between 2006 and 2013 were included. Image analysis of CT scans was used to calculate Lumbar skeletal muscle index (LSMI), and mean muscle attenuation (MA). The SIR was quantified by the preoperative neutrophil to lymphocyte ratio (NLR) and albumin levels. Correlation and multivariate regression analysis was performed to identify independent relationships between patient SIR and muscle characteristics.RESULTS: Patients with NLR > 3 had significantly lower LSMI and lower MA than those with NLR < 3 [LSMI = 42.07 cmm vs 44.27 cmm (P = 0.002) and MA = 30.04 Hounsfield unit (HU) vs 28.36 HU (P = 0.016)]. Multivariate logistic regression analysis showed that high NLR [odds ratio (OR) = 1.78 (95% confidence interval [CI]: 1.29-2.45), P < 0.001] and low albumin [OR = 1.80 (95% CI: 1.17-2.74), P = 0.007] were independent predictors of reduced muscle mass. High NLR was significantly related with a low mean MA and hence myosteatosis [OR = 1.60 (95% CI: 1.03-2.49), P = 0.038].CONCLUSIONS: These results highlight a direct association between myopenia, myosteatosis, and the host SIR in patients with operable CRC. A better understanding of factors that regulate muscle changes such as myopenia and myosteatosis may lead to the development of novel therapies that influence a more metabolically "healthy" skeletal muscle and potentially alter cancer outcomes.

KW - Adult

KW - Aged

KW - Aged, 80 and over

KW - Body Composition

KW - Colorectal Neoplasms/complications

KW - Elective Surgical Procedures

KW - Female

KW - Humans

KW - Male

KW - Middle Aged

KW - Multivariate Analysis

KW - Muscle, Skeletal/diagnostic imaging

KW - Muscular Diseases/diagnostic imaging

KW - Prognosis

KW - Systemic Inflammatory Response Syndrome/etiology

KW - Tomography, X-Ray Computed

U2 - 10.1097/SLA.0000000000001113

DO - 10.1097/SLA.0000000000001113

M3 - Article

C2 - 25643288

SN - 0003-4932

VL - 263

SP - 320

EP - 325

JO - Annals of surgery

JF - Annals of surgery

IS - 2

ER -

Low Muscularity and Myosteatosis Is Related to the Host Systemic Inflammatory Response in Patients Undergoing Surgery for Colorectal Cancer

Abstract

Keywords

UN SDGs

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