Avaliação de diferentes ferramentas para avaliação da composição corporal no câncer colorectal - uma revisão sistemática

MONACO-FERREIRA, Daniela Vicinansa; MAGRO, Daniéla Oliveira; COY, Claudio Saddy Rodrigues

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Brasil

Arquivos de Gastroenterologia

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Brasil

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Sumário

REVIEW • Arq. Gastroenterol. 59 (2) • Apr-Jun 2022 • https://doi.org/10.1590/S0004-2803.202202000-52 copiar

Avaliação de diferentes ferramentas para avaliação da composição corporal no câncer colorectal - uma revisão sistemática

Autoria SCIMAGO INSTITUTIONS RANKINGS

RESUMO

Contexto:

O estado nutricional de pacientes com câncer colorretal (CCR) tem impacto na resposta ao tratamento e na morbidade. Uma avaliação eficaz da composição corporal inclui as medidas de gordura visceral e massa livre de gordura e está sendo usada atualmente no diagnóstico do estado nutricional. O melhor entendimento das ferramentas nutricionais para avaliação da composição corporal em pacientes com CCR pode impactar no desfecho.

Métodos:

Revisão sistemática conduzida de acordo com as diretrizes itens preferidos de relatórios para revisões sistemáticas e meta-análise (PRISMA). Foi realizada uma pesquisa bibliográfica nas bases de dados BVS (LILACS), PubMed, Embase, Cochrane, Scopus e Web of Science.

Resultados:

Para a busca inicial, 97 estudos foram selecionados e 51 manuscritos duplicados foram excluídos. Assim, 46 foram revisados e sete estudos incluídos, com um total de 4.549 pacientes. Entre eles estavam um ensaio clínico, um estudo prospectivo (coorte), dois estudos retrospectivos de coorte e dois estudos transversais. Todos os estudos incluíram composição corporal avaliada por tomografia computadorizada (TC), um com impedância bioelétrica, um com força de preensão manual e dois empregaram a circunferência muscular do braço e o índice de massa corporal.

Conclusão:

As evidências atuais sugerem que a TC tem melhor acurácia no diagnóstico de sarcopenia, gordura visceral e miopenia em indivíduos com CCR. Mais estudos são necessários para identificar pontos de corte para essas alterações agravadas pelo CCR.

Palavras-chave:
Neoplasias colorretais; composição corporal; sarcopenia; tomografia computadorizada; avaliação nutricional

First author; year; country	Study design	Sample size	Mean [SD]	Gender ratio (M:F)	Patient characteristics	Nutritional assessment method used	Nutritional outcomes
			Median
			(range)
			Age (years)
Jones et al. 2020; UK¹⁸18. Jones DJ, Lal S, Strauss BJ, Todd C, Pilling M, Burden ST. Measurement of Muscle Mass and Sarcopenia Using Anthropometry, Bioelectrical Impedance, and Computed Tomography in Surgical Patients with Colorectal Malignancy: Comparison of Agreement Between Methods. Nutrition and Cancer . 2020;72:1074-83.	Clinical trial	100	69.6±11.5	67:23	Primary colorectal tumor	CT scans, BIA, MAMC, handgrip	BIA and MAMC are woefully inadequate to detect reduced muscle mass in patients with CRC, when compared with the measurements of CT-derived muscle mass at L3

Shirdel et al. 2020; Sweden²⁰20. Shirdel M, Andersson F, Myte R, Axelsson J, Rutegård M, Blomqvist L, et al. Body composition measured by computed tomography is associated with colorectal cancer survival, also in early-stage disease. Acta Oncol. 2020;59:799-808.	Retrospective cohort	974	67.7 (37.8-89.6)	462:512	CRC	Computed tomography	Sarcopenia measured by CT may thus have potential clinical utility, for prognostication, therapeutic decision making and the identification of patients in need of early nutritional or pharmacological anti-sarcopenic intervention

Martin et al. 2018; Canada²³23. Martin L, Hopkins J, Malietzis G, Jenkins JT, Sawyer MB, Brisebois R, et al. Assessment of Computed Tomography (CT)-Defined Muscle and Adipose Tissue Features in Relation to Short-Term Outcomes After Elective Surgery for Colorectal Cancer: A Multicenter Approach. Ann Surg Oncol. 2018;25:2669-80.	Cohorts	2100	66.6±11.9	1270:830	Primary CRC with preoperative CT	Computed tomography	CT-defined multidimensional body habitus is independently associated with length of hospital stay and hospital readmission

Sabel et al. 2013; USA²¹21. Sabel MS, Terjimanian M, Conlon AS, Griffith KA, Morris AM, Mulholland MW, et al. Analytic morphometric assessment of patients undergoing colectomy for colon cancer. J Surgical Oncology 2013;108:169-75.	Retrospective cohort	302	67.9±12.4	157:145	Resection for colon cancer	CT scans, BMI	Analytic morphometric analysis provided objective data that stratified both complications of treatment and outcome better than commonly used variable (age, BMI, co-morbidities) among patients with colorectal cancer

Malietzis et al. 2016; UK²²22. Malietzis G, Currie AC, Athanasiou T, Johns N, Anyamene N, Glynne-Jones R, et al. Influence of body composition profile on outcomes following colorectal cancer surgery. Br J Surg. 2016;103:572-80.	Prospective database	805	69 (61-77)	472:333	Colorectal resection	Computed tomography	Myopenia may have an independent prognostic effect on cancer survival for patients with colorectal cancer. Muscle depletion may represent a modifiable risk. factor in patients with colorectal cancer and needs to be targeted as a relevant endpoint of heath recommendations

Van Vugt et al. 2017; Germany¹⁷17. van Vugt JL, Levolger S, Gharbharan A, Koek M, Niessen WJ, Burger JW, et al. A comparative study of software programmes for cross-sectional skeletal muscle and adipose tissue measurements on abdominal computed tomography scans of rectal cancer patients. J Cachexia Sarcopenia Muscle . 2017;8:285-97.	Cross-sectional	50	62 (33-81)	29:21	Rectal cancer resection	Abdominal CT scans and comparison of four software progs for assessment of body composition	Four different software progs. have an excellent agreement to measure VAT and SAT, and CSMA in abdominal CT scans

Van Roekel et al. 2017; Netherlands¹⁹19. van Roekel EH, Bours MJL, Te Molder MEM, Breedveld-Peters JJL, Olde Damink SWM, Schouten LJ, et al. Associations of adipose and muscle tissue parameters at colorectal cancer diagnosis with long-term health-related quality of life . Qual Life Res. 2017;26:1745-59.	Cross-sectional	218	67.8±11.9	127:91	CRC survivors recruited 2-10 years post-diagnosis	Abdominal CT scans, visceral adiposity, muscle wasting, sarcopenia, BMI	Visceral obesity and sarcopenia are relatively common in CRC diagnosis; we found no significant associations of these parameters with long-term HRQoL in stage I-III CRC survivors

Cut-off points
CT- scan	Men	Women	References
Sarcopenic
SMI cm²/m²	≤52.4	≤38.5	Van Vugt, 2017¹⁷17. van Vugt JL, Levolger S, Gharbharan A, Koek M, Niessen WJ, Burger JW, et al. A comparative study of software programmes for cross-sectional skeletal muscle and adipose tissue measurements on abdominal computed tomography scans of rectal cancer patients. J Cachexia Sarcopenia Muscle . 2017;8:285-97.
SMI cm²/m²	<43.0 if BMI <25 and <53.0 if BMI ≥25	<41.0 any BMI	Roekel, 2017¹⁹19. van Roekel EH, Bours MJL, Te Molder MEM, Breedveld-Peters JJL, Olde Damink SWM, Schouten LJ, et al. Associations of adipose and muscle tissue parameters at colorectal cancer diagnosis with long-term health-related quality of life . Qual Life Res. 2017;26:1745-59.
SMI cm²/m²	≤52.4	≤38.5	Malietzis, 2016²²22. Malietzis G, Currie AC, Athanasiou T, Johns N, Anyamene N, Glynne-Jones R, et al. Influence of body composition profile on outcomes following colorectal cancer surgery. Br J Surg. 2016;103:572-80.
SMI cm²/m²	<52.4	<38.5	Jones, 2019¹⁸18. Jones DJ, Lal S, Strauss BJ, Todd C, Pilling M, Burden ST. Measurement of Muscle Mass and Sarcopenia Using Anthropometry, Bioelectrical Impedance, and Computed Tomography in Surgical Patients with Colorectal Malignancy: Comparison of Agreement Between Methods. Nutrition and Cancer . 2020;72:1074-83.
SMI cm²/m²	z-score below - 0.5	z-score below - 0.5	Martin, 2018²³23. Martin L, Hopkins J, Malietzis G, Jenkins JT, Sawyer MB, Brisebois R, et al. Assessment of Computed Tomography (CT)-Defined Muscle and Adipose Tissue Features in Relation to Short-Term Outcomes After Elective Surgery for Colorectal Cancer: A Multicenter Approach. Ann Surg Oncol. 2018;25:2669-80.
SMI cm²/m²	Tertile cutoffs 43.1 to 49.2	Tertile cutoffs 32.9 to 38.1	Shirdel, 2020²⁰20. Shirdel M, Andersson F, Myte R, Axelsson J, Rutegård M, Blomqvist L, et al. Body composition measured by computed tomography is associated with colorectal cancer survival, also in early-stage disease. Acta Oncol. 2020;59:799-808.
Myosteatosis
SMR cm²/m²	z-score below 0	z-score 0	Martin, 2018²³23. Martin L, Hopkins J, Malietzis G, Jenkins JT, Sawyer MB, Brisebois R, et al. Assessment of Computed Tomography (CT)-Defined Muscle and Adipose Tissue Features in Relation to Short-Term Outcomes After Elective Surgery for Colorectal Cancer: A Multicenter Approach. Ann Surg Oncol. 2018;25:2669-80.
SMR cm²/m²	Tertile cutoffs 38.5 to 46.1	Tertile cutoffs 36.1 to 43.6	Shirdel, 2020²⁰20. Shirdel M, Andersson F, Myte R, Axelsson J, Rutegård M, Blomqvist L, et al. Body composition measured by computed tomography is associated with colorectal cancer survival, also in early-stage disease. Acta Oncol. 2020;59:799-808.
Visceral obesity
Area of visceral fat (cm²)	≥163.8	≥80.0	Van Vugt, 2017¹⁷17. van Vugt JL, Levolger S, Gharbharan A, Koek M, Niessen WJ, Burger JW, et al. A comparative study of software programmes for cross-sectional skeletal muscle and adipose tissue measurements on abdominal computed tomography scans of rectal cancer patients. J Cachexia Sarcopenia Muscle . 2017;8:285-97.
Area of visceral fat (cm²)	≥160	≥80.0	Roekel, 2017¹⁹19. van Roekel EH, Bours MJL, Te Molder MEM, Breedveld-Peters JJL, Olde Damink SWM, Schouten LJ, et al. Associations of adipose and muscle tissue parameters at colorectal cancer diagnosis with long-term health-related quality of life . Qual Life Res. 2017;26:1745-59.
Area of visceral fat (cm²)	≥163.8	≥80.1	Malietzis, 2016²²22. Malietzis G, Currie AC, Athanasiou T, Johns N, Anyamene N, Glynne-Jones R, et al. Influence of body composition profile on outcomes following colorectal cancer surgery. Br J Surg. 2016;103:572-80.

VATI (cm²/m²)	z-score above 0.5	z-score above 0.5	Martin, 2018²³23. Martin L, Hopkins J, Malietzis G, Jenkins JT, Sawyer MB, Brisebois R, et al. Assessment of Computed Tomography (CT)-Defined Muscle and Adipose Tissue Features in Relation to Short-Term Outcomes After Elective Surgery for Colorectal Cancer: A Multicenter Approach. Ann Surg Oncol. 2018;25:2669-80.
VAT (cm²)	Tertile cut-offs 133.4 to 233	Tertile cut-offs 63.2 to 120.0	Shirdel, 2020²⁰20. Shirdel M, Andersson F, Myte R, Axelsson J, Rutegård M, Blomqvist L, et al. Body composition measured by computed tomography is associated with colorectal cancer survival, also in early-stage disease. Acta Oncol. 2020;59:799-808.
SAT (cm²)	Tertile cut-off 117.7 to 166.6	Tertile cut-offs 155.2 to 232.8	Shirdel, 2020²⁰20. Shirdel M, Andersson F, Myte R, Axelsson J, Rutegård M, Blomqvist L, et al. Body composition measured by computed tomography is associated with colorectal cancer survival, also in early-stage disease. Acta Oncol. 2020;59:799-808.

Myopenia
Myopenic obesity	Myopenia* + BMI >30 kg/m²	Myopenia* + BMI >30 kg/m²	Malietzis, 2016²²22. Malietzis G, Currie AC, Athanasiou T, Johns N, Anyamene N, Glynne-Jones R, et al. Influence of body composition profile on outcomes following colorectal cancer surgery. Br J Surg. 2016;103:572-80.

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[1] Corresponding author: Daniela Vicinansa Monaco-Ferreira. E-mail: danielamonacoferreira@gmail.com