Search

Background: Colorectal cancer (CRC) is one of the most common tumors worldwide, with rising numbers of elderly patients affected. Nutritional status significantly influences tumor prognosis. We aimed to investigate the association of subcutaneous and visceral adipose tissue and skeletal muscle mass with the prognosis of the oldest-old patients with CRC, after surgery. Patients: We retrospectively reviewed 210 patients >75 years who underwent surgical treatment at the Department of Gastrointestinal Surgery, Beijing Hospital, between December 2010 and December 2020. Materials: Subcutaneous adipose, visceral adipose, and skeletal muscle areas were measured using BMI_CT. The cut-off values of the CT measurements were then confirmed using receiver operating characteristic (ROC) curve analysis. Results: Subcutaneous adipose tissue index (SATI), visceral adipose tissue index (VATI), and total adipose tissue index (TATI) were significantly associated with sex and BMI. Notably, the oldest-old CRC patients with high SATI, VATI, and TATI scores exhibited significantly higher rates of wound complications and reduced postoperative hospitalization durations. Intriguingly, patients with high VATI and TATI demonstrated significantly better 5-year Overall survival (OS), Cancer-specific survival (CSS), and Disease-free survival (DFS) than patients in the other groups. Similar results were observed in patients with a high visceral-to-subcutaneous fat ratio (VSR) and skeletal muscle index (SMI) scores. Conclusion: Significantly improving skeletal muscle content while concurrently managing the total adipose content, especially visceral adipose tissue, may aid in extending the survival time of oldest-old patients with CRC after surgery.

Aim: Despite their promise as prognostic factors in colorectal cancer, anthropometric data are frequently contradictory or difficult to interpret, with single body-composition parameters often investigated in isolation or heterogeneous clinical cohorts used in analyses. We sought to assess a spectrum of body-composition parameters in a highly selected cohort with locally advanced rectal cancer in a bid to determine those with strongest prognostic potential in this specific setting. Materials/methods: Between 2014 and 2020, 78 individuals received neoadjuvant chemotherapy, or chemoradiotherapy, followed by radical surgery in the treatment of locally advanced rectal adenocarcinoma at Oxford University Hospitals Trust. Demographic, treatment-related, perioperative, and short-term outcomes data were assessed. Body-composition parameters included BMI, and those derived from pre-operative computed-tomography imaging: skeletal mass index (SMI), visceral fat area (VFA), subcutaneous fat area (SFA), perinephric fat area (PFA) visceral-to-subcutaneous fat ratio (V/S), sarcopenia, and sarcopenic obesity (SO). Results: Pre-operative body-composition parameters exhibited particularly strong correlation with post-operative outcomes, with VFA (p = 0.002), V/S (p = 0.019), SO (p = 0.012), and PFA (p = 0.0016) all associated with an increased length of hospital stay. Univariate and multivariate analyses demonstrated V/S to be the sole independent body-composition risk factor to be associated with an increased risk of developing Clavien–Dindo complications ≥ 2 (p = 0.033) as well as an increased length of stay (p = 0.005). Conclusion: Among patients with locally advanced rectal cancer, high visceral-to-subcutaneous fat ratio is the body-composition parameter most strongly associated with poor early post-operative outcomes. This should be considered in patient selection and prehabilitation protocols. What does this paper add to the literature? : Our study demonstrates that among body composition parameters, high visceral-to-subcutaneous fat ratio is strongly associated with increased risk of post-operative complications and increased length of stay in patients undergoing surgery for advanced rectal cancer. [ABSTRACT FROM AUTHOR]

Objectives: We compared the associations of 3 computed tomography (CT)-based abdominal adiposity indexes with non-alcoholic fatty liver disease (NAFLD) among middle-aged Korean men and women. Methods: The participants were 1366 men and 2480 women community-dwellers aged 30-64 years. Three abdominal adiposity indexes—visceral fat area (VFA), subcutaneous fat area (SFA), and visceral-to-subcutaneous fat ratio (VSR)—were calculated from abdominal CT scans. NAFLD was determined by calculating the Liver Fat Score from comorbidities and blood tests. An NAFLD prediction model that included waist circumference (WC) as a measure of abdominal adiposity was designated as the base model, to which VFA, SFA, and VSR were added in turn. The area under the receiver operating characteristic curve (AUC), integrated discrimination improvement (IDI), and net reclassification improvement (NRI) were calculated to quantify the additional predictive value of VFA, SFA, and VSR relative to WC. Results: VFA and VSR were positively associated with NAFLD in both genders. SFA was not significantly associated with NAFLD in men, but it was negatively associated in women. When VFA, SFA, and VSR were added to the WC-based NAFLD prediction model, the AUC improved by 0.013 (p

Background/aim: The sex-specific effect of the visceral-to-subcutaneous fat ratio (VSR) before gastrectomy on postoperative survival in patients with gastric cancer (GC) remains unclear. This study measured the preoperative VSR in patients with GC and analyzed its relationship with 5-year overall survival (OS) and relapse-free survival (RFS) by sex., Patients and Methods: This prospective study included 540 patients with GC undergoing gastrectomy. Preoperative visceral and subcutaneous fat volumes were measured using computed tomography, and the VSR was calculated. A cutoff value for the VSR was established using 5-year survival data, and its association with survival was analyzed using the Kaplan-Meier method, log-rank tests, and multivariate regression analysis., Results: Among the 459 patients analyzed (300 males and 159 females), OS and RFS were significantly lower in the low-VSR group than in the high-VSR group in males (OS: 76.2% vs. 88.1%, p=0.01; RFS: 74.6% vs. 86.0%, p=0.02). In females, no difference in OS was observed between the groups, whereas the high-VSR group had significantly lower RFS than that of the low-VSR group (RFS: 74.7% vs. 88.9%, p=0.01). Multivariate analysis showed that a low VSR was an independent poor predictor of OS in males and a high VSR was an independent poor predictor of RFS in females., Conclusion: In patients with GC, the sex-dependent preoperative VSR was a potentially useful predictor of postoperative survival., (Copyright © 2024 International Institute of Anticancer Research (Dr. George J. Delinasios), All rights reserved.)

Abstract: Aims/Introduction: To investigate whether the ratio of visceral fat area (VFA) to subcutaneous fat area (SFA; V/S ratio) could be predictive of cardiovascular disease (CVD) as compared with VFA or SFA in patients with diabetes. Materials and Methods: A total of 682 patients with type 2 diabetes (mean age 64 ± 13 years; 41% women) were enrolled. VFA (cm2) and SFA (cm2) were assessed by a dual bioelectrical impedance analyzer. The patients were divided into four groups according to the quartiles of the V/S ratio. The study end‐point was the first occurrence or recurrence of CVD. Results: Over a median follow up of 2.5 years, 21 patients reached the end‐point. The number of patients who reached the end‐point was increased along with the increasing of the V/S ratio quartiles. The V/S ratio was significantly associated with incident or recurrent CVD (hazard ratio [HR] 1.82, 95% CI: 1.09–3.04, P = 0.021) after adjusting for estimated glomerular filtration rate (HR 0.98, 95% CI: 0.96–1.00), brain‐type natriuretic peptide (HR 1.00, 95% CI: 1.00–1.01), use of antiplatelet agents (HR 4.26, 95% CI: 1.63–11.13), coefficient of variation of R‐R intervals (HR 0.85, 95% CI: 0.69–1.10) and glycated hemoglobin (HR 1.37, 95% CI: 1.05–1.79). The addition of the V/S ratio to age, estimated glomerular filtration rate, brain‐type natriuretic peptide, antiplatelet agents and glycated hemoglobin significantly improved classification performance for CVD using net reclassification improvement (0.60, 95% CI: 0.21–1.00) and the integrated discrimination improvement (0.02, 95% CI: 0.00–0.05). Conclusions: The V/S ratio measured by dual bioelectrical impedance analyzer is an independent predictor of CVD in patients with type 2 diabetes. [ABSTRACT FROM AUTHOR]

Purpose: Visceral obesity has been recognized as a predictor of metabolic risk factors. However, few studies have evaluated the metabolic risks in subjects with normal waist circumference (WC). We aimed to examine if the visceral-to-subcutaneous fat ratio (VSR) has diagnostic value to identify multiple metabolic risk factors in subjects with normal WC, compared with visceral fat area (VFA) and subcutaneous fat area (SFA). Methods: This is a cross-sectional study in which we have compared mean VFA, SFA, and VSR according to each metabolic risk factor. We performed a receiver operating characteristic (ROC) curve analysis for VFA, SFA, and VSR to assess their accuracy in picking out two or more non-adipose factors for metabolic syndrome. Results: For each metabolic risk factor, mean VSRs were significantly different between groups (risk-absent group vs risk-present group) in men and women, except for men with low highdensity lipoprotein. However, mean VFAs and SFAs showed no significant differences between groups. VSR showed superior diagnostic values in predicting at least two non-adipose metabolic risk factors in men and similar diagnostic value in women. Areas under ROC curves for VSR and VFA were 0.705 and 0.649 in men (P=0.028) and 0.798 and 0.785 in women (P=0.321). Conclusion: For men with a normal WC, VSR appeared to effectively predict the presence of multiple metabolic risk factors. Thus, VSR may serve as an indicator for identifying men who have a normal WC and multiple metabolic risk factors. [ABSTRACT FROM AUTHOR]

Objectives: We compared the associations of 3 computed tomography (CT)-based abdominal adiposity indexes with non-alcoholic fatty liver disease (NAFLD) among middle-aged Korean men and women., Methods: The participants were 1366 men and 2480 women community-dwellers aged 30-64 years. Three abdominal adiposity indexes-visceral fat area (VFA), subcutaneous fat area (SFA), and visceral-to-subcutaneous fat ratio (VSR)-were calculated from abdominal CT scans. NAFLD was determined by calculating the Liver Fat Score from comorbidities and blood tests. An NAFLD prediction model that included waist circumference (WC) as a measure of abdominal adiposity was designated as the base model, to which VFA, SFA, and VSR were added in turn. The area under the receiver operating characteristic curve (AUC), integrated discrimination improvement (IDI), and net reclassification improvement (NRI) were calculated to quantify the additional predictive value of VFA, SFA, and VSR relative to WC., Results: VFA and VSR were positively associated with NAFLD in both genders. SFA was not significantly associated with NAFLD in men, but it was negatively associated in women. When VFA, SFA, and VSR were added to the WC-based NAFLD prediction model, the AUC improved by 0.013 (p<0.001), 0.001 (p=0.434), and 0.009 (p=0.007) in men and by 0.044 (p<0.001), 0.017 (p<0.001), and 0.046 (p<0.001) in women, respectively. The IDI and NRI were increased the most by VFA in men and VSR in women., Conclusions: Using CT-based abdominal adiposity indexes in addition to WC may improve the detection of NAFLD. The best predictive indicators were VFA in men and VSR in women.

Recent studies have shown that body composition is an important factor that affects surgical site infection (SSI). However, each study has utilized different body composition criteria. Therefore, in this study, we aim to determine the most predictable body composition criteria for the prediction of SSI after gastrectomy. The visceral fat area (VFA), subcutaneous fat area (SFA), and muscle area were assessed by a preoperative-stage computed tomographic (CT) scan. To compare the predictive performance of body composition for SSI, logistic regression models were used, and the models were compared using the receiver operation characteristic (ROC) curve and the area under the curve (AUC) value. Of the 1038 eligible patients, 58 patients (5.6%) developed SSI. The VFA-to-SFA ratio showed the best predictive performance (mean AUC 75.11). The cutoff value for the SSI of the VFA-to-SFA ratio was 0.94, and the sensitivity and specificity were 67.86% and 77.65%, respectively. A multivariate logistic analysis indicated that a total gastrectomy (OR, 2.13; p = 0.017), stage III or IV cancer (OR, 2.66; p = 0.003), and a high VFA-to-SFA ratio (OR, 8.09; p < 0.001) were independent risk factors for SSI after gastrectomy. The VFA-to-SFA ratio is the most predictable body composition model for use in predicting the incidence of SSI after gastrectomy. [ABSTRACT FROM AUTHOR]

Background: Sarcopenia and obesity have been suspected as factors associated with efficacy of treatment and prognosis in various malignancies. This study aimed to investigate the association of pretreatment sarcopenia and visceral obesity with efficacy and prognosis of first- and second-generation epidermal growth factor receptor (EGFR) tyrosine kinase inhibitor (TKI) for patients with non-small cell lung cancer (NSCLC) and positive EGFR mutation., Methods: We retrospectively collected 167 NSCLC patients with mutant EGFR who had started EGFR-TKI monotherapy between October 2007 and August 2018 at our hospital. We classified 167 patients into two groups, according to the definition of underweight based on the World Health Organization (WHO) body mass index (BMI) classification and the Japanese sex-specific cut-off values of the following computed tomography (CT) images-assessed markers of pretreatment sarcopenia or visceral obesity, such as psoas muscle index (PMI), intramuscular adipose tissue content (IMAC) and visceral-to-subcutaneous fat ratio (VSR) at lumbar vertebra L3 level. We compared overall survival (OS) and progression-free survival (PFS) of two groups by Kaplan-Meier curves and log-rank tests. Using multivariate Cox proportional hazard analyses adjusted by age, neutrophil-to-lymphocyte ratio, performance status, EGFR mutation types and EGFR-TKI lines, and extra-pulmonary metastases or three or more than 3 metastatic sites, we searched independent prognostic factors of OS and PFS of EGFR-TKI therapy., Results: The OS (median 26.0 vs. 32.3 months, P = 0.02) and PFS (9.1 vs. 14.8 months, P = 0.03) of patients with BMI < 18.5 were significantly shorter than those of patients with BMI ≥ 18.5. However, there was no significant difference in OS and PFS according to PMI, IMAC and VSR. The multivariate analyses detected only BMI < 18.5 as an unfavorable prognostic factor of shorter OS (hazard ratio (HR) 1.70, 95% confidence interval (CI) 1.03 - 2.81, P = 0.04) and PFS (HR 1.72, 95% CI 1.11 - 2.67, P = 0.02)., Conclusions: Pretreatment underweight was a significant prognostic factor of poor PFS and OS of EGFR-TKI therapy. However, neither pretreatment sarcopenia nor visceral obesity was associated with prognosis of EGFR-TKI. Underweight may be a surrogate for advanced disease burden., Competing Interests: The authors declare that they have no conflict of interests., (Copyright 2019, Minami et al.)

Purpose: Visceral obesity has been recognized as a predictor of metabolic risk factors. However, few studies have evaluated the metabolic risks in subjects with normal waist circumference (WC). We aimed to examine if the visceral-to-subcutaneous fat ratio (VSR) has diagnostic value to identify multiple metabolic risk factors in subjects with normal WC, compared with visceral fat area (VFA) and subcutaneous fat area (SFA)., Methods: This is a cross-sectional study in which we have compared mean VFA, SFA, and VSR according to each metabolic risk factor. We performed a receiver operating characteristic (ROC) curve analysis for VFA, SFA, and VSR to assess their accuracy in picking out two or more non-adipose factors for metabolic syndrome., Results: For each metabolic risk factor, mean VSRs were significantly different between groups (risk-absent group vs risk-present group) in men and women, except for men with low high-density lipoprotein. However, mean VFAs and SFAs showed no significant differences between groups. VSR showed superior diagnostic values in predicting at least two non-adipose metabolic risk factors in men and similar diagnostic value in women. Areas under ROC curves for VSR and VFA were 0.705 and 0.649 in men ( P =0.028) and 0.798 and 0.785 in women ( P =0.321)., Conclusion: For men with a normal WC, VSR appeared to effectively predict the presence of multiple metabolic risk factors. Thus, VSR may serve as an indicator for identifying men who have a normal WC and multiple metabolic risk factors., Competing Interests: Disclosure The authors report no conflicts of interest in this work.