SARCOPENIA E MALNUTRIZIONE: ASPETTI LEGATI ALLA PROGNOSI - Dott.ssa Elisa D'Angelo UO Radioterapia Oncologica Azienda Ospedaliero Universitaria ...
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SARCOPENIA E
MALNUTRIZIONE: ASPETTI
LEGATI ALLA PROGNOSI
Dott.ssa Elisa D’Angelo
UO Radioterapia Oncologica
Azienda Ospedaliero Universitaria Policlinico di ModenaMALNUTRIZIONE E SARCOPENIA: PROGNOSI IN HNSCC
• LA PRESENZA DI SARCOPENIA E MALNUTRIZIONE, POSSONO AIUTARCI A
PREVEDERE LA PROGNOSI DI UN PAZIENTE AFFETTO DA NEOPLASIA DEL
DISTRETTO TESTA E COLLO?
• POSSONO SARCOPENIA E MALNUTRIZIONE ESSERE CONSIDERATI COME
FATTORI PROGNOSTICI?
2PROGNOSI DEL HNSCC
AIRTUM, registro 2020; SEER database 2017 3MALNUTRIZIONE E SARCOPENIA
• MALNUTRITION: «a state resulting from lack of intake or uptake of nutrition that
leads to altered body composition(decreased fat free mass) and body cell mass
leading to diminished physical and mental function and impaired clinical outcome
from disease»
• SARCOPENIA: «syndrome of its own characterized by the progressive and
generalised loss of skeletal muscle mass, strength and function (performance) with a
consequent risk of adverse outcomes»
T. Cederholm , 2017 4MALNUTRIZIONE
DRM is a specific type of malnutrition caused by a concomitant disease. DRM is triggered mainly by a
disease-specific inflammatory response.
DRM with inflammation is a catabolic condition characterized by an inflammatory response, including
anorexia and tissue breakdown, elicited by an underlying disease.
T. Cederholm , 2017 5PREVALENZA IN HNSCC
1952 pazienti
6Malnutrizione legata al cancro
7
Arends, 2017; T. Cederholm , 2017SARCOPENIA: MECCANISMO
8
Ongaro et al., 2017• SARCOPENIA
E CACHESSIA
9
Argiles, 2014MALNUTRIZIONE: COME VALUTARLA?
10
Cederholm , 2019MALNUTRIZIONE: COME VALUTARLA?
11
Cederholm, 2019Sarcopenia: come valutarla?
Conclusions: Despite the different
existing body composition
assessment tools, it seems that
skeletal muscle mass (SMM)
measurement at the level of
cervical spine C3 vertebra may be
a reliable method for SMM
assessment as it strongly
correlates with cross-sectional
area measures at the level of L3
and it allows a cost-effective body
composition assessment without
the need for additional radiation
exposure.
12Sarcopenia ed impatto prognostico
• To determine whether radiologically
defined sarcopenia at the C3 or L3 level
as measured by computed tomography
or magnetic resonance imaging is
prognostic of overall survival (OS) in
head and neck cancers (HNCs).
• Ruolo della sarcopenia radiologica ed
impatto sulla OS nel paziente
• Dei dieci studi selezionati nella
metanalisi, 8 dimostrano un impatto
della sarcopenia radiologicamente
misurata sulla OS nei pazienti hnscc
13
Wong, 2020Sarcopenia e impatto prognostico: metanalisi studi in pazienti in cura per HNSCC
A total of 6211 studies with 1059 pooled
patients.
Sarcopenia prevalence ranged from 6.6 to
64.6% pre-treatment and 12.4 to 65.8%
post-treatment. Pre-treatment sarcopenia
was associated with reduced overall survival
(HR 2.07; 95%CI, 1.47e2.92, p < 0.0001, I2 ¼
49%) with similar findings for post-
treatment sarcopenia (HR 2.93; 95%CI,
2.00e4.29, p < 0.00001, I2 ¼ 0%) with
moderate to low heterogeneity exhibited
amongst studies respectively. The certainty
of evidence for overall survival according to
GRADE was low for pre-treatment
sarcopenia and moderate for post-treatment
sarcopenia
CT-defined sarcopenia is independently associated with reduced overall survival in patients
with HNC and holds a clinically meaningful prognostic value. Consensus regarding sarcopenia
assessment and definitions is warranted 14
Findlay, 2020Sarcopenia ed impatto prognostico:
PROSPECTIVE
Stratificati per PS
Sarcopenia (CT to C3)
WHO
750 pts HNSCC
Stratificati per stadio
di malattia
Sarcopenic patients had significantly poorer survival rates, especially those with lower
performance status and locally advanced disease. STRONG ASSOCIATION Van Rijn Dekker, 2020 15
Skeletal muscle depletion is a marker of more advanced disease…???MALNUTRIZIONE E SARCOPENIA: PROGNOSI IN HNSCC
• LA PRESENZA DI SARCOPENIA E MALNUTRIZIONE, POSSONO AIUTARCI A
PREVEDERE LA PROGNOSI DI UN PAZIENTE AFFETTO DA NEOPLASIA DEL
DISTRETTO TESTA E COLLO?
• POSSONO SARCOPENIA E MALNUTRIZIONE ESSERE CONSIDERATI COME
FATTORI PROGNOSTICI?
• PERCHÉ LA SARCOPENIA IMPATTA SULLA OS?
16Sarcopenia ed impatto prognostico: compliance ai trattamenti
sarcopenia is
significantly
associated with
grade physician-
rated xerostomia
and dysphagia
Van Rijn Dekker, 2020 17Sarcopenia ed impatto prognostico: compliance ai trattamenti
PROSPECTIVE: ….Optimal nutritional support follow-up,
including weekly consultation with a dietician and an
oncologist and daily weight monitoring, was performed.
Sarcopenia was determined by measuring the skeletal
muscles at the L3 vertebra on the planning CT scan for
radiotherapy. For each treatment group (RT or RTCT), we
assessed the prognostic value of sarcopenia for disease-free
survival (DFS) and overall survival (OS) and its impact on
treatment-related toxicity.
RESULTS:
Overall, sarcopenia was associated with OS and DFS in a
multivariate analysis (HR 1.9 [1.1–3.25] and 1.7 [1.06–2.71],
respectively).
Sarcopenia was not related to higher treatment-related
toxicity
18
Thureau, 2021Impatto prognostico della sarcopenia in HNSCC
sottoposti a CRT definitiva
221 patients with head and neck cancer:
definitive CCRT
Sarcopenia was defined as an L3 muscle
index ofImpatto della sarcopenia in HNSCC sottoposti a
CRT definitiva
Sarcopenia alone did not decrease survival among our patients
20
Cho, 2018Sarcopenia ed infiammazione impatto sulla prognosi in HNSCC
sarcopenia may reflect the increased metabolic activity of
more aggressive tumors, leading to systemic inflammation
and muscle wasting
Sarcopenia was closely associated with PFS and OS when
accompanied by systemic inflammation (WBC, ANC, and NLR).
21
Cho, 2018; Muscaritoli, 2017Sarcopenia ed interruzione RT in HNSCC
22MALNUTRIZIONE CANCRO-ASSOCIATA
23MALNUTRIZIONE CANCRO-ASSOCIATA
Both % of weight loss and BMI independently predict survival (P < 0.01)
24MALNUTRIZIONE CANCRO-ASSOCIATA
Risk of reduced survival is a
function of BMI and % weight loss.
BMI-adjusted WL grading system is a useful tool in efforts to predict survival because it is independent
of cancer site, stage, and PS and strongly discriminates survival differences.
25CONCLUSIONI
26CONCLUSIONI
Welch ML, Jaffray DA. 2017You can also read
