Muscle mass evaluation among ambulatory cancer patients in China: Comparison of different methods and association with survival.

Abstract

12080 Background: Cancer patients are at high risk of malnutrition and cachexia. Muscle mass reduction (MMR) is one of the three phenotypic criteria to diagnose malnutrition in the Global Leadership Initiative on Malnutrition (GLIM) framework, but there are no consensus about what method should be used to evaluate MMR in clinical practice. Among multiple methods to evaluate MMR, muscle mass index (MMI) in computed tomography (CT) image was considered to be accurate but not convenient in clinical practice. This study aimed to compare the correlations between different methods of measuring MMR and to assess their relevance to survival. Methods: A single-center cohort study was conducted among ambulatory cancer patients who were receiving intravenous anti-cancer therapy. All participants underwent CT, calf circumference (CC) measurement, bioelectrical impedance analysis (BIA) and hand grip strength measurement. MRR was identified by MMI in CT image at the level of lumbar vertebra 3 (L3), CC, fat-free mass index (FFMI) and appendicular skeletal muscle index (ASMI) in BIA respectively. Low MMI was defined as MMI < 43 in men with body mass index (BMI) < 25kg/ 2 , < 53 in men with BMI≥25kg/ 2 or < 43 in women. Low CC was defined as CC< 34cm in men or < 33cm in women. Low FFMI was defined as FFMI < 17kg/m 2 in men or < 15kg/m 2 in women. Low ASMI was set as ASMI < 7.0kg/m 2 in men or < 5.7kg/m 2 in women. Low muscle strength was defined by hand grip strength < 28kg in men or < 18kg in women. The correlation between low MMI and MMR diagnosed by other methods were calculated. The correlation between MMR, low muscle strength and one-year mortality was also evaluated. Results: A total of 312 consecutive patients were included. Of the 312 patients 62.8% (196/312) were male and 37.2% (116/312) were female. The median age of the patients was 59.0 years (range, 21-80y; interquartile range 52.0-65.0y). FFMI and SMI diagnosed by BIA correlated with MMI diagnosed by CT (Pearson Correlation 0.798 and 0.738 respectively). Except for low hand grip strength (p = 0.005, HR 2.482, 95%CI 1.324-4.655), no single indicators for MMR indicated higher one-year mortality. However, in combination of MMI, CC, FFMI and ASMI, MMR indicated higher one-year mortality (p = 0.004, HR 2.549, 95%CI 1.342-4.843). Conclusions: FFMI and SMI diagnosed by BIA correlated with MMI diagnosed by CT, indicating that BIA can be a good choice in evaluating MMR. Low hand grip strength and MMR diagnosed using multiple methods indicated higher one-year mortality, underscoring the importance of measuring muscle strength as well as evaluating muscle mass.