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The prevalence of sarcopenia and cachexia in older patients with localized colorectal cancer

  • Troels Gammeltoft Dolin
    Correspondence
    Corresponding author at: Department of Medicine, Herlev and Gentofte Hospital, Borgmester Ib Juuls Vej 1, DK-2730 Herlev, Denmark.
    Affiliations
    Department of Medicine, Copenhagen University Hospital - Herlev and Gentofte, Herlev, Denmark

    CopenAge – Copenhagen Center for Clinical Age Research - University of Copenhagen, Denmark
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  • Marta Kramer Mikkelsen
    Affiliations
    Department of Oncology, Copenhagen University Hospital Herlev and Gentofte, Herlev, Denmark
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  • Henrik Loft Jakobsen
    Affiliations
    Department of Gastrointestinal Surgery, Copenhagen University Hospital - Herlev and Gentofte, Herlev, Denmark
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  • Anders Vinther
    Affiliations
    Department of Physiotherapy and Occupational Therapy - Copenhagen University Hospital, Herlev and Gentofte, Herlev, Denmark

    Hospital Secretariat and Communications; Research, Copenhagen University Hospital - Herlev and Gentofte, Herlev, Denmark
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  • Bo Zerahn
    Affiliations
    Department of Clinical Physiology and Nuclear Medicine, Copenhagen University Hospital, Herlev and Gentofte, Denmark
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  • Dorte Lisbet Nielsen
    Affiliations
    Department of Oncology, Copenhagen University Hospital Herlev and Gentofte, Herlev, Denmark

    Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
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  • Julia Sidenius Johansen
    Affiliations
    Department of Medicine, Copenhagen University Hospital - Herlev and Gentofte, Herlev, Denmark

    Department of Oncology, Copenhagen University Hospital Herlev and Gentofte, Herlev, Denmark

    Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
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  • Author Footnotes
    1 Contributed equally as senior co-authors.
    Cecilia Margareta Lund
    Footnotes
    1 Contributed equally as senior co-authors.
    Affiliations
    Department of Medicine, Copenhagen University Hospital - Herlev and Gentofte, Herlev, Denmark

    CopenAge – Copenhagen Center for Clinical Age Research - University of Copenhagen, Denmark

    Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
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  • Author Footnotes
    1 Contributed equally as senior co-authors.
    Charlotte Suetta
    Footnotes
    1 Contributed equally as senior co-authors.
    Affiliations
    Department of Medicine, Copenhagen University Hospital - Herlev and Gentofte, Herlev, Denmark

    Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark

    Geriatric Research Unit, Department of Geriatric and Palliative Medicine, Copenhagen University Hospital, Bispebjerg, Copenhagen, Denmark

    Department of Clinical Physiology and Nuclear Medicine, Copenhagen University Hospital, Herlev and Gentofte, Denmark
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  • Author Footnotes
    1 Contributed equally as senior co-authors.
Published:November 21, 2022DOI:https://doi.org/10.1016/j.jgo.2022.11.001

      Abstract

      Introduction

      The incidence of colorectal cancer (CRC) increases with age. In combination with an ageing population, the number of older patients undergoing surgical treatment for CRC is therefore expected to increase. Sarcopenia and cachexia are potentially modifiable risk factors of a negative surgical outcome. Sarcopenia can be categorized into primary (age-related) and secondary where diseases, such as malignancy, are influential factors. We aimed to investigate the prevalence of preoperative sarcopenia and cachexia in older (≥65 years) vulnerable patients with localized CRC.

      Materials and Methods

      Patients included in the randomized study “Geriatric assessment and intervention in older vulnerable patients undergoing resection for colorectal cancer,” were screened for sarcopenia and cachexia prior to surgery. All patients in the present cohort were considered vulnerable with Geriatric 8 ≤ 14 points. Sarcopenia was defined according to European Guidelines (EWGSOP2), based on low muscle strength—low handgrip-strength and/or slow 5xChair-Stand-Test—and low appendicular lean mass assessed by dual-energy X-ray absorptiometry. Cachexia was defined as self-reported unintended weight loss >5% within three months or 2–5% with body mass index <20 kg/m2.

      Results

      Sixty-four patients (mean age 79.6 years ±6.4 years, 36 women) were assessed. Of these, 28% (n = 18, 11 women) had low muscle strength and 13% (n = 8, 4 women) fulfilled the criteria for sarcopenia, however, 33% (n = 21, 13 women) had low muscle mass. There was no correlation between low muscle strength and low muscle mass (r = 0.16, P = 0.22). The prevalence of cachexia was 36% (n = 23, 16 women). Low muscle mass was associated with cachexia (φ = 0.38, P = 0.005), but there was no association between sarcopenia and cachexia (φ = 0.01, P = 1.0).

      Discussion

      Despite the included patients who fulfilled the criteria for vulnerability according to G8, relatively few (28%) had low muscle strength. Moreover, there was poor overlap between the prevalence of sarcopenia according to the EWGSOP2 guidelines (13%) and prevalence of low muscle mass (33%) in older patients with CRC. Of note also, there was no association between sarcopenia and cachexia, but an association between cachexia and low muscle mass, which highlights the importance of assessing muscle mass in patients with cancer.
      Trial registration: The GEPOC trial has been prospectively registered at http://clinicaltrials.gov (NCT03719573).

      Keywords

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