SARC-F as a screening tool to detect computed tomography-based sarcopenia and myosteatosis among older adults with cancer.

The European Working Group on Sarcopenia in Older People (EWGSOP) recommends SARC-F as a tool for identifying sarcopenia among older adults. However, the role of SARC-F among older adults with cancer remains unexplored. We aimed to evaluate the diagnostic utility of SARC-F to identify those with sarcopenia, or low muscle mass (using skeletal muscle index [SMI]), and myosteatosis (using skeletal muscle density [SMD]) from computed tomography (CT) imaging and the association of SARC-F with all-cause mortality. Older adults (≥60 years) presenting for initial consultation at UAB medical oncology clinic who underwent geriatric assessment were enrolled in a prospective cohort study. We identified study participants who completed SARC-F screening and had available CT imaging within 60 days of study enrollment. Using single-slice CT images at the L3 vertebral level, we computed SMI and SMD using published methods. Sarcopenia and myosteatosis were defined using published cutpoints. We calculated the sensitivity and specificity of SARC-F for detecting low muscle mass and low muscle density using published thresholds. Finally, we computed the impact of SARC-F and CT measures on overall survival using Kaplan-Meier curves and Cox regression models, after adjusting for age, sex, cancer type, and cancer stage. We identified 212 older adults with a median age of 68.8 years; with 60.8% males, 76.6% whites, and pancreatic cancer (21.2%) being the most common malignancy. In the overall cohort, 30.7% had abnormal SARC-F using published cutpoints. SARC-F ≥ 4 had a sensitivity of 35% and a specificity of 76% to identify low muscle mass. SARC-F ≥ 4 had a sensitivity of 38% and a specificity of 74% to identify low muscle density. Those with SARC-F ≥ 4 and low SMI/SMD had worse survival compared to those with low SMI/SMD alone. Incorporating SARC-F improved survival prognostication beyond SMI and SMD (HR = 3.1; p < 0.001; Harrel's C from 0.73 to 0.76). SARC-F as a screening tool has limited diagnostic utility for identifying older adults with low muscle mass and/or density. However, SARC-F retains prognostic value independent of CT-based muscle measures in predicting mortality among older adults with cancer.

Hess DL ，Harmon C ，Bhatia S ，Williams GR ，Giri S ... -  《Cancer Medicine》

Performance of SARC-F in Regard to Sarcopenia Definitions, Muscle Mass and Functional Measures.

Bahat G ，Yilmaz O ，Kılıç C ，Oren MM ，Karan MA ... -  《-》

Deep learning-based assessment of CT markers of sarcopenia and myosteatosis for outcome assessment in patients with advanced pancreatic cancer after high-intensity focused ultrasound treatment.

To evaluate the prognostic value of CT-based markers of sarcopenia and myosteatosis in comparison to the Eastern Cooperative Oncology Group (ECOG) score for survival of patients with advanced pancreatic cancer treated with high-intensity focused ultrasound (HIFU). For 142 retrospective patients, the skeletal muscle index (SMI), skeletal muscle radiodensity (SMRD), fatty muscle fraction (FMF), and intermuscular fat fraction (IMFF) were determined on superior mesenteric artery level in pre-interventional CT. Each marker was tested for associations with sex, age, body mass index (BMI), and ECOG. The prognostic value of the markers was examined in Kaplan-Meier analyses with the log-rank test and in uni- and multivariable Cox proportional hazards (CPH) models. The following significant associations were observed: Male patients had higher BMI and SMI. Patients with lower ECOG had lower BMI and SMI. Patients with BMI lower than 21.8 kg/m2 (median) also showed lower SMI and IMFF. Patients younger than 63.3 years (median) were found to have higher SMRD, lower FMF, and lower IMFF. In the Kaplan-Meier analysis, significantly lower survival times were observed in patients with higher ECOG or lower SMI. Increased patient risk was observed for higher ECOG, lower BMI, and lower SMI in univariable CPH analyses for 1-, 2-, and 3-year survival. Multivariable CPH analysis for 1-year survival revealed increased patient risk for higher ECOG, lower SMI, lower IMFF, and higher FMF. In multivariable analysis for 2- and 3-year survival, only ECOG and FMF remained significant. CT-based markers of sarcopenia and myosteatosis show a prognostic value for assessment of survival in advanced pancreatic cancer patients undergoing HIFU therapy. The results indicate a greater role of myosteatosis for additional risk assessment beyond clinical scores, as only FMF was associated with long-term survival in multivariable CPH analyses along ECOG and also showed independence to ECOG in group analysis. • This study investigates the prognostic value of CT-based markers of sarcopenia and myosteatosis for patients with pancreatic cancer treated with high-intensity focused ultrasound. • Markers for sarcopenia and myosteatosis showed a prognostic value besides clinical assessment of the physical status by the Eastern Cooperative Oncology Group score. In contrast to muscle size measurements, the myosteatosis marker fatty muscle fraction demonstrated independence to the clinical score. • The results indicate that myosteatosis might play a greater role for additional patient risk assessments beyond clinical assessments of physical status.

Nowak S ，Kloth C ，Theis M ，Marinova M ，Attenberger UI ，Sprinkart AM ，Luetkens JA ... -  《-》

Comparing SARC-F with SARC-CalF for screening sarcopenia in advanced cancer patients.

Sarcopenia is a commonly prevalent malnutrition condition and serves as a valuable adverse prognostic indicator for survival in patients with cancer. A rapid and convenient screening test for sarcopenia would be helpful for patients. Aim of the study was to evaluate the diagnostic value of SARC-F and SARC-F combined with calf circumference (SARC-CalF) for screening cancer-related sarcopenia in cancer population. A total of 309 patients with cancer who had routine abdominal comptued tomography (CT) images within 30 days were enrolled in this cross-sectional cohort. Sarcopenia was determined as the presence of both low muscle mass (LMM) and low muscle strength; muscle mass was evaluated by CT-scan, and muscle strength was evaluated by handgrip strength (HGS). Two different diagnostic criteria (Western criteria and Eastern criteria) were used as the reference standards. The sensitivity and specificity analyses of the SARC-F and SARC-CalF were calculated. The receiver operating characteristic (ROC) curves and the area under the ROC curves (AUC) were used to compare the diagnostic value of SARC-F and SARC-CalF for sarcopenia. The prevalence of LMM and sarcopenia in the patient group was 85.1% and 50.5% by Western criteria. Corresponding figures were lower as 42.4% and 26.2% by Eastern criteria. In the overall study population, when sarcopenia defined by the Eastern criteria, sensitivity and specificity of SARC-CalF were 66.6% and 70.1%, whereas that of SARC-F were 32.1% and 90.7%, respectively. The AUCs for SARC-CalF and SARC-F were 0.75 (95% confidence interval (CI) 0.70-0.80) and 0.70 (95% CI 0.64-0.75), respectively (P = 0.003). Against the Western criteria, SARC-CalF also had better sensitivity (55.1% vs. 22.4%) but lower specificity (76.4% vs. 92.1%) than that of SARC-F. The AUCs of SARC-CalF and SARC-F were 0.70 (95% CI 0.65-0.75) and 0.68 (95% CI 0.62-0.73), respectively, but the difference was not significant (P = 0.211). SARC-CalF significantly increases the sensitivity and overall diagnostic accuracy of SARC-F for screening sarcopenia. SARC-CalF can be a rapid screening tool for sarcopenia in patients with cancer.

Fu X ，Tian Z ，Thapa S ，Sun H ，Wen S ，Xiong H ，Yu S ... -  《-》

Diagnosing sarcopenia at the point of imaging care: analysis of clinical, functional, and opportunistic CT metrics.

Yao L ，Petrosyan A ，Fuangfa P ，Lenchik L ，Boutin RD ... -  《-》