Sarcopenia, Precardial Adipose Tissue and High Tumor Volume as Outcome Predictors in Surgically Treated Pleural Mesothelioma

Our plain-English summary of Sarcopenia, Precardial Adipose Tissue and High Tumor Volume as Outcome Predictors in Surgically Treated Pleural Mesothelioma, by O.G. Verhoek, L. Jungblut, O. Lauk, et al (Diagnostics, 2022).

The study

• Authors: O.G. Verhoek, L. Jungblut, O. Lauk, C. Blüthgen, I. Opitz, T. Frauenfelder, K. Martini
• Journal: Diagnostics
• Published: 2022;12(1)
• Cited by: 4 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Background: We evaluated the prognostic value of Sarcopenia, low precardial adipose-tissue (PAT), and high tumor-volume in the outcome of surgically-treated pleural mesothelioma (PM).

Methods: From 2005 to 2020, consecutive surgically-treated PM-patients having a pre-operative computed tomography (CT) scan were retrospectively included. Sarcopenia was assessed by CT-based parameters measured at the level of the fifth thoracic vertebra (TH5) by excluding fatty-infiltration based on CT-attenuation. The findings were stratified for gender, and a threshold of the 33rd percentile was set to define sarcopenia. Additionally, tumor volume as well as PAT were measured. The findings were correlated with progression-free survival and long-term mortality.

Results: Two-hundred-seventy-eight PM-patients (252 male; 70.2 ± 9 years) were included. The mean progression-free survival was 18.6 ± 12.2 months, and the mean survival time was 23.3 ± 24 months. Progression was associated with chronic obstructive pulmonary disease (COPD) (p = <0.001), tumor-stage (p = 0.001), and type of surgery (p = 0.026). Three-year mortality was associated with higher patient age (p = 0.005), presence of COPD (p < 0.001), higher tumor-stage (p = 0.015), and higher tumor-volume (p < 0.001). Kaplan-Meier statistics showed that sarcopenic patients have a higher three-year mortality (p = 0.002). While there was a negative correlation of progression-free survival and mortality with tumor volume (r = 0.281, p = 0.001 and r = -0.240, p < 0.001; respectively), a correlation with PAT could only be shown for epithelioid PM (p = 0.040).

Conclusions: Sarcopenia as well as tumor volume are associated with long-term mortality in surgically treated PM-patients. Further, while there was a negative correlation of progression-free survival and mortality with tumor volume, a correlation with PAT could only be shown for epithelioid PM.

In plain English

This retrospective study included 278 patients (252 male, mean age 70.2) operated on for pleural mesothelioma in 2005 to 2020. The authors measured chest muscle on pre-operative CT scans, defining sarcopenia (low muscle) as below the sex-matched 33rd percentile. They also measured fat in front of the heart (precardial adipose tissue, PAT) and tumor volume. Mean time to progression was 18.6 months and mean survival 23.3 months. Death within three years was associated with older age, chronic obstructive pulmonary disease, higher tumor stage and larger tumors. Patients with sarcopenia had shorter three-year survival, most clearly by paraspinal muscle area. Sarcopenia was not associated with progression. For PAT and progression, one overall test showed a link that regression confirmed only in the epithelioid subtype. PAT results for mortality conflicted; the authors concluded a PAT link was shown only for epithelioid disease. Asbestos exposure was more common among patients who died within three years. Asbestos-exposed men had smaller tumors than unexposed men. The authors concluded that tumor volume and sarcopenia predict outcome. Listed limitations included the retrospective design and a single reader.

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: Retrospective study of consecutive surgically treated patients, using measurements from pre-operative CT scans compared with progression and survival
• Who was studied: 278 consecutive patients who had surgery for pleural mesothelioma (252 male; mean age 70.2 plus or minus 9 years), September 2005 to November 2020, at the authors' institution (University Hospital Zurich, Switzerland, per the author affiliations). Histology: 161 epithelioid, 9 sarcomatoid, 76 biphasic, 8 not defined.
• Exposure: The factors studied were CT-based body and tumor measurements: muscle area at the fifth thoracic vertebra (sarcopenia defined as below the sex-matched 33rd percentile), precardial adipose tissue, and tumor volume. A history of asbestos exposure was recorded as a patient characteristic. No fiber types, jobs or doses were reported.
• Main results:
  • Across the cohort, mean time to progression was 18.6 months (SD 11.7) and mean survival time was 23.3 months (SD 24).
  • Three-year mortality was associated with higher patient age (p = 0.005), presence of COPD (p less than 0.001), higher tumor stage (p = 0.015) and higher tumor volume (p less than 0.001).
  • In Kaplan-Meier analysis, patients with sarcopenia had higher three-year mortality. The clearest difference was for sarcopenia defined by paraspinal area: mean 3-year survival 34.5 [95% CI 27 to 42] without sarcopenia vs 20.4 [15 to 25] with sarcopenia, p = 0.002 (units not stated in the table). The other muscle measures gave p = 0.027 (pectoral), 0.028 (rotator cuff) and 0.041 (total muscle area).
  • The muscle measures defining sarcopenia were not associated with tumor progression.
  • Tumor volume was negatively correlated with tumor progression (r = −0.281, p less than 0.001) and with mortality (r = −0.240, p less than 0.001).
  • For precardial adipose tissue and progression, Pearson correlation across all patients showed a negative correlation (r = −0.152, printed as p < 0.037). Linear regression did not confirm this overall (R = 0.152, R2 0.023, p = 0.073). In epithelioid mesothelioma evaluated separately, regression did show a correlation (R = 0.320, R2 0.102, p = 0.004).
  • For precardial adipose tissue and mortality, the reported results conflict. Pearson correlation was not shown overall (r = −0.066, p = 0.251), nor in epithelioid (r = 0.208) or biphasic (r = −0.102, p = 0.594) disease. Overall linear regression showed no correlation (p = 0.503). The same paragraph then reports a regression correlation in epithelioid (R = 0.063, R2 0.004, p less than 0.001) and biphasic (R = 0.018, R2 0.000, p less than 0.001) mesothelioma, with near-zero R2 values. The authors' conclusion states a PAT correlation was shown only for epithelioid mesothelioma.
  • Among patients with at least 36 months of follow-up (n = 250), a history of asbestos exposure was recorded in 130 (65%) of the 199 who died within three years vs 6 (12%) of the 51 alive at three years (p less than 0.001). The authors described asbestos exposure as correlating with worse outcome.
  • Male patients with a history of asbestos exposure had lower tumor volume than male patients without one (194.2 vs 331.9 cm3; p = 0.035). No female patient had asbestos exposure.
• The authors' conclusion: The authors concluded that tumor volume and sarcopenia are predictive markers for patient outcome in surgically treated pleural mesothelioma. They also stated that progression-free survival and mortality correlated negatively with tumor volume, while a correlation with PAT was shown only for epithelioid mesothelioma.
• Limitations the authors state:
  • Muscle was measured at the fifth thoracic vertebra rather than the more common third lumbar vertebra.
  • Contrast-enhanced and non-contrast scans were measured with the same attenuation thresholds.
  • CT slice thickness varied, which can cause measurement errors.
  • Only one reader performed the measurements.
  • The study was retrospective, and patients received different treatments.
  • The study did not distinguish curative from palliative surgery.
  • PAT is hard to measure accurately in mesothelioma because the tumor often lies close to or infiltrates mediastinal fat.

Topics

Medical terms in this study, explained in our Lexicon: Pleural Mesothelioma, Progression-Free Survival, COPD, Epithelioid.

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