Sarcopenia and Pleural Mesothelioma: The Current Knowledge

Our plain-English summary of Sarcopenia and Pleural Mesothelioma: The Current Knowledge, by N.D. Karakousis, K.I. Gourgoulianis, N. Papanas, et al (Muscles, 2024).

The study

• Authors: N.D. Karakousis, K.I. Gourgoulianis, N. Papanas, O.S. Kotsiou
• Journal: Muscles
• Published: 2024;3(1):48-59
• Type of article: Review
• Read it: PubMed · Publisher · Free full text

Abstract

Pleural mesothelioma (PM) is a tumor related to adverse prognosis. The PM WHO classification has mainly identified three major subtypes of PM which are epithelioid, biphasic, and sarcomatoid. Sarcopenia is a medical issue related to a reduction in muscle mass and strength. It represents a major health issue globally because it is related to adverse effects such as hospitalization, increased length of stay, disability, increased morbidity and mortality and augmented health care expenditures. In this literature review, we attempted to examine the upcoming association between sarcopenia and PM. As recorded by the current literature, muscle loss in PM subjects was related to poorer survival and lower levels of activity. Subjects with PM had increased rates of pre-sarcopenia and malnutrition, while pre-sarcopenia was related to worse activity levels, and malnutrition was related to worse quality of life (QoL). Both tumor volume and sarcopenia were related to long-term mortality in surgically treated PM subjects, while sarcopenia was present both pre-operatively and post-operatively in these subjects. In addition, post-operative sarcopenic subjects showed a decreased 3-year overall survival (OS) in comparison with those who did not have sarcopenia, while pre-operative sarcopenia was importantly related to an increased rate of post-operative adverse outcomes. More studies are needed to validate these claims.

In plain English

This article was a non-systematic literature review, not a new study. The authors searched PubMed, Google Scholar and EMBASE from August 1975 to December 2023 for original, English-language, non-animal studies on sarcopenia (loss of muscle mass and strength) and pleural mesothelioma, and described four studies. In one study of 61 patients with malignant pleural mesothelioma, 54% were pre-sarcopenic and 38% were malnourished. In a second study of 18 patients, fewer of the 9 who lost muscle mass survived 12 months or more from follow-up than of the 9 who maintained it (p = 0.002). In a retrospective study of 278 surgically treated patients, those with sarcopenia had higher three-year mortality (p = 0.002). In a study of 86 surgically treated patients, those with sarcopenia after surgery had 3-year overall survival of 34.9%, compared with 57.6% in those without sarcopenia (p = 0.03). The authors concluded that muscle loss was related to poorer survival, but that more studies are needed. They noted that the studies were few and small, with short follow-up. The review did not examine asbestos exposure.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Non-systematic literature review of original studies (English-language, non-animal)
• Who was studied: Published studies found in PubMed, Google Scholar and EMBASE from August 1975 to December 2023. Four studies of pleural mesothelioma patients were described: 61, 18, 278 and 86 patients.
• Exposure: Not an asbestos exposure study. The factor examined was sarcopenia, low muscle mass, pre-sarcopenia and muscle loss in patients with pleural mesothelioma. These were measured by DXA scans or CT scans in the reviewed studies.
• Main results:
  • Jeffery et al. [62], 61 patients with malignant pleural mesothelioma: 54% were pre-sarcopenic and 38% were malnourished.
  • Jeffery et al. [62]: daily time in light activity was lower in pre-sarcopenic patients than in those without sarcopenia (median 25.4% vs 32.3%, p = 0.008). Malnourished patients had worse health-related quality of life than well-nourished patients (mean 69.0 vs 84.4, p less than 0.001).
  • Jeffery et al. [63], 18 patients: fewer of the 9 with loss of appendicular skeletal muscle mass survived 12 months or more from follow-up, compared with the 9 who maintained it (p = 0.002).
  • Verhoek et al. [64], retrospective study of 278 surgically treated pleural mesothelioma patients (252 male), 2005 to 2020: patients with sarcopenia had increased three-year mortality (p = 0.002).
  • Faccioli et al. [65], 86 surgically treated patients with malignant pleural mesothelioma: sarcopenia was present before surgery in 57 (66%) and after surgery in 61 (74%).
  • Faccioli et al. [65]: patients with sarcopenia after surgery had 3-year overall survival of 34.9%, compared with 57.6% in non-sarcopenic patients (p = 0.03). Sarcopenia before surgery was related to more post-operative adverse outcomes (65% vs 41%, p = 0.04).
• The authors' conclusion: The authors concluded that muscle loss in pleural mesothelioma patients was related to poorer survival and lower activity levels, and that sarcopenia and tumor volume were related to long-term mortality after surgery. They added that more studies are needed to confirm these findings.
• Limitations the authors state:
  • Few studies exist, the data are scarce, and follow-up periods were mostly short.
  • Most studies had few participants and may come from a single center.

Topics

Medical terms in this study, explained in our Lexicon: Pleural Mesothelioma, Prognosis, WHO Classification, Epithelioid, Biphasic Mesothelioma, Sarcomatoid, Quality of Life, Overall Survival.

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