CT‐Based Body Composition and Frailty as Predictors of Survival Among Older Adults With Gastrointestinal Malignancies
ABSTRACT Background Older adults with cancer are at an increased risk of treatment related toxicities and early death. Routinely collected clinico‐demographic characteristics inadequately explain this increased risk limiting accurate prognostication. Prior studies have suggested that altered body co...
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Wiley
2025-02-01
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| Series: | Journal of Cachexia, Sarcopenia and Muscle |
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| Online Access: | https://doi.org/10.1002/jcsm.13664 |
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| author | Smith Giri Christian Harmon Daniel Hess Elizabeth M. Cespedes Feliciano Ijeamaka Anyene Fumagalli Bette Caan Leon Lenchik Karteek Popuri Vincent Chow Mirza Faisal Beg Smita Bhatia Grant R. Williams |
| author_facet | Smith Giri Christian Harmon Daniel Hess Elizabeth M. Cespedes Feliciano Ijeamaka Anyene Fumagalli Bette Caan Leon Lenchik Karteek Popuri Vincent Chow Mirza Faisal Beg Smita Bhatia Grant R. Williams |
| author_sort | Smith Giri |
| collection | DOAJ |
| description | ABSTRACT Background Older adults with cancer are at an increased risk of treatment related toxicities and early death. Routinely collected clinico‐demographic characteristics inadequately explain this increased risk limiting accurate prognostication. Prior studies have suggested that altered body composition and frailty are independently associated with worse survival among older adults with cancer; however, their combined influence remains unclear. Methods We used data from a single‐institution prospective cohort study of older adults (≥ 60 years) who underwent geriatric assessment (GA) at the time of initial consultation with a medical oncologist from September 2017 to December 2020 and available baseline abdominal computed tomography within 60 days of GA. Using multi‐slice CT images from T12 to L5 level, we assessed volumetric measures of skeletal muscle (SMV), visceral adipose tissue (VATV), subcutaneous adipose tissue (SATV) and averaged skeletal muscle density (SMD), computing sex‐specific z for each measure. Frailty was measured using a 44‐item frailty index using the deficit accumulation approach. Primary outcome of interest was overall survival (OS) defined as time from GA to death or last follow up. We used multivariable Cox regression model to study the independent association between the above four body composition measurements and OS adjusted for baseline confounders and frailty. Results We included 459 patients with a mean age of 69.7 ± 7.5 years, 60% males and 77% non‐Hispanic Whites. Most had colorectal (27%) or pancreatic cancer (20%) and 48% had stage IV disease. Over a median follow up of 39.4 months, 209 patients (46%) died. In multivariable Cox regression models adjusted for age, sex, race, cancer type, cancer stage and frailty, skeletal muscle volume (HR 0.74; 95% CI 0.58–0.96; p = 0.02, per 1 SD increment) was independently associated with OS. The addition of body composition variables to baseline clinico‐demographic variables and frailty led to a slightly improved model discrimination. Conclusions SMV is independently associated with OS among older adults with newly diagnosed gastrointestinal cancers. Capturing body composition measurements in oncology practice may provide additional prognostic information for older adults with cancer above and beyond what is captured in routine clinical assessment including frailty. |
| format | Article |
| id | doaj-art-d5d88cdcfcc14aea982b1c9309b195a1 |
| institution | DOAJ |
| issn | 2190-5991 2190-6009 |
| language | English |
| publishDate | 2025-02-01 |
| publisher | Wiley |
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| series | Journal of Cachexia, Sarcopenia and Muscle |
| spelling | doaj-art-d5d88cdcfcc14aea982b1c9309b195a12025-08-20T02:57:01ZengWileyJournal of Cachexia, Sarcopenia and Muscle2190-59912190-60092025-02-01161n/an/a10.1002/jcsm.13664CT‐Based Body Composition and Frailty as Predictors of Survival Among Older Adults With Gastrointestinal MalignanciesSmith Giri0Christian Harmon1Daniel Hess2Elizabeth M. Cespedes Feliciano3Ijeamaka Anyene Fumagalli4Bette Caan5Leon Lenchik6Karteek Popuri7Vincent Chow8Mirza Faisal Beg9Smita Bhatia10Grant R. Williams11Institute for Cancer Outcomes and Survivorship University of Alabama at Birmingham Birmingham Alabama USAInstitute for Cancer Outcomes and Survivorship University of Alabama at Birmingham Birmingham Alabama USADepartment of Medicine University of Alabama at Birmingham Birmingham Alabama USADivision of Research Kaiser Permanente, Northern California Oakland California USADivision of Research Kaiser Permanente, Northern California Oakland California USADivision of Research Kaiser Permanente, Northern California Oakland California USADepartment of Radiology Wake Forest University School of Medicine Winston‐Salem North Carolina USADepartment of Computer Science Memorial University of Newfoundland St John's Newfoundland and Labrador CanadaSchool of Engineering Science Simon Fraser University Burnaby British Columbia CanadaSchool of Engineering Science Simon Fraser University Burnaby British Columbia CanadaInstitute for Cancer Outcomes and Survivorship University of Alabama at Birmingham Birmingham Alabama USAInstitute for Cancer Outcomes and Survivorship University of Alabama at Birmingham Birmingham Alabama USAABSTRACT Background Older adults with cancer are at an increased risk of treatment related toxicities and early death. Routinely collected clinico‐demographic characteristics inadequately explain this increased risk limiting accurate prognostication. Prior studies have suggested that altered body composition and frailty are independently associated with worse survival among older adults with cancer; however, their combined influence remains unclear. Methods We used data from a single‐institution prospective cohort study of older adults (≥ 60 years) who underwent geriatric assessment (GA) at the time of initial consultation with a medical oncologist from September 2017 to December 2020 and available baseline abdominal computed tomography within 60 days of GA. Using multi‐slice CT images from T12 to L5 level, we assessed volumetric measures of skeletal muscle (SMV), visceral adipose tissue (VATV), subcutaneous adipose tissue (SATV) and averaged skeletal muscle density (SMD), computing sex‐specific z for each measure. Frailty was measured using a 44‐item frailty index using the deficit accumulation approach. Primary outcome of interest was overall survival (OS) defined as time from GA to death or last follow up. We used multivariable Cox regression model to study the independent association between the above four body composition measurements and OS adjusted for baseline confounders and frailty. Results We included 459 patients with a mean age of 69.7 ± 7.5 years, 60% males and 77% non‐Hispanic Whites. Most had colorectal (27%) or pancreatic cancer (20%) and 48% had stage IV disease. Over a median follow up of 39.4 months, 209 patients (46%) died. In multivariable Cox regression models adjusted for age, sex, race, cancer type, cancer stage and frailty, skeletal muscle volume (HR 0.74; 95% CI 0.58–0.96; p = 0.02, per 1 SD increment) was independently associated with OS. The addition of body composition variables to baseline clinico‐demographic variables and frailty led to a slightly improved model discrimination. Conclusions SMV is independently associated with OS among older adults with newly diagnosed gastrointestinal cancers. Capturing body composition measurements in oncology practice may provide additional prognostic information for older adults with cancer above and beyond what is captured in routine clinical assessment including frailty.https://doi.org/10.1002/jcsm.13664agingfrailtygeriatric oncologymyosteatosissarcopenia |
| spellingShingle | Smith Giri Christian Harmon Daniel Hess Elizabeth M. Cespedes Feliciano Ijeamaka Anyene Fumagalli Bette Caan Leon Lenchik Karteek Popuri Vincent Chow Mirza Faisal Beg Smita Bhatia Grant R. Williams CT‐Based Body Composition and Frailty as Predictors of Survival Among Older Adults With Gastrointestinal Malignancies Journal of Cachexia, Sarcopenia and Muscle aging frailty geriatric oncology myosteatosis sarcopenia |
| title | CT‐Based Body Composition and Frailty as Predictors of Survival Among Older Adults With Gastrointestinal Malignancies |
| title_full | CT‐Based Body Composition and Frailty as Predictors of Survival Among Older Adults With Gastrointestinal Malignancies |
| title_fullStr | CT‐Based Body Composition and Frailty as Predictors of Survival Among Older Adults With Gastrointestinal Malignancies |
| title_full_unstemmed | CT‐Based Body Composition and Frailty as Predictors of Survival Among Older Adults With Gastrointestinal Malignancies |
| title_short | CT‐Based Body Composition and Frailty as Predictors of Survival Among Older Adults With Gastrointestinal Malignancies |
| title_sort | ct based body composition and frailty as predictors of survival among older adults with gastrointestinal malignancies |
| topic | aging frailty geriatric oncology myosteatosis sarcopenia |
| url | https://doi.org/10.1002/jcsm.13664 |
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