BACKGROUND: Age-related loss of functional muscle mass is associated with reduced functional ability and life expectancy. In disseminated cancer, age-related muscle loss may be exacerbated by cachexia and poor nutritional intake, increasing functional decline, morbidity and accelerate death. Patients with spinal metastases frequently present for decompressive surgery with decision to operate based upon functional assessment. A subjective assessment of physical performance has, however, been shown to be a poor indicator of life expectancy in these patients. We aimed to develop an objective measure based upon lean muscle mass to aid decision making, in these individuals, by investigating the association between muscle mass and 1-year survival. METHODS: Muscle mass was calculated as total psoas area (TPA)/ vertebral body area (VBA), by two independent blinded doctors from CT images, acquired within 7 days of spinal metastases surgery, at the mid L3 vertebral level. Outcome at 1 year following surgery was recorded from a prospectively updated metastatic spinal cord compression database. RESULTS: 86 patients were followed for 1 year, with an overall mortality of 39.5%. Mortality rates at 1 year were significantly high among patients in the lowest quartile of muscle mass, compared with those in the highest quartile (57.1 vs 23.8%, p=0.02). CONCLUSION: Death within 1 year in individuals with spinal metastases is related to lean muscle mass at presentation. Assessment of lean muscle mass may inform decision to operate in patients with spinal metastases.

3rd Medical School Charles' University Prague Prague Czech Republic

Anaesthetic Department Division Surgery Royal Derby Hospital Derby DE223NE UK

MRC Arthritis Research UK Centre for Musculoskeletal Ageing Research Royal Derby Hospital Centre University of Nottingham Nottingham DE22 3DT UK

School of Graduate Entry Medicine and Health Derby City General Hospital University of Nottingham Derby DE22 3DT UK

Spinal Unit Division of Surgery Royal Derby Hospital Derby DE223NE UK

Zobrazit více v PubMed

J Am Geriatr Soc. 2002 May;50(5):889-96 PubMed

Nestle Nutr Workshop Ser Clin Perform Programme. 2002;6:151-9; discussion 160-2 PubMed

Am J Clin Nutr. 2009 Apr;89(4):1173-9 PubMed

Lancet. 1998 Mar 21;351(9106):871-5 PubMed

J Appl Physiol (1985). 1998 Jul;85(1):115-22 PubMed

Spine (Phila Pa 1976). 1990 Nov;15(11):1110-3 PubMed

Ann Surg Oncol. 2008 Jul;15(7):1918-22 PubMed

J Gastrointest Surg. 2010 Nov;14 (11):1832-7 PubMed

Clin Cancer Res. 2009 Apr 15;15(8):2920-6 PubMed

Obesity (Silver Spring). 2009 Nov;17(11):2082-8 PubMed

Front Physiol. 2012 Jul 11;3:260 PubMed

Appl Physiol Nutr Metab. 2008 Oct;33(5):997-1006 PubMed

Clin Cancer Res. 2007 Jun 1;13(11):3264-8 PubMed

Eur Spine J. 2013 Mar;22(3):565-8 PubMed

Lancet Oncol. 2008 Jul;9(7):629-35 PubMed

Am J Epidemiol. 1998 Apr 15;147(8):755-63 PubMed

Lancet Oncol. 2008 Jul;9(7):605-7 PubMed

J Clin Oncol. 2011 Aug 1;29(22):3072-7 PubMed

Am J Clin Nutr. 2010 Apr;91(4):1133S-1137S PubMed

Spine (Phila Pa 1976). 2005 Oct 1;30(19):2186-91 PubMed

Spine (Phila Pa 1976). 2001 Feb 1;26(3):298-306 PubMed

Am J Clin Nutr. 2004 Apr;79(4):613-8 PubMed

J Gerontol A Biol Sci Med Sci. 2003 Nov;58(11):1012-7 PubMed

Annu Rev Nutr. 1997;17:527-58 PubMed

J Am Coll Surg. 2010 Aug;211(2):271-8 PubMed

Am J Clin Nutr. 2009 Jun;89(6):1895-900 PubMed

PLoS One. 2012;7(1):e29330 PubMed

Br J Nutr. 2006 Nov;96(5):895-901 PubMed

J Appl Physiol (1985). 2004 Dec;97(6):2333-8 PubMed

J Gerontol A Biol Sci Med Sci. 2002 Oct;57(10):B359-65 PubMed

Clin Cancer Res. 2009 Nov 15;15(22):6973-9 PubMed

Lancet. 2005 Aug 20-26;366(9486):643-8 PubMed

J Lab Clin Med. 2001 Apr;137(4):231-43 PubMed