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European Radiology
Published in: European Radiology 9/2019

01-09-2019 | Magnetic Resonance Imaging | Oncology

Fat-free muscle area measured by magnetic resonance imaging predicts overall survival of patients undergoing radioembolization of colorectal cancer liver metastases

Authors: Anton Faron, Claus C. Pieper, Frederic C. Schmeel, Alois M. Sprinkart, Daniel L. R. Kuetting, Rolf Fimmers, Jonel Trebicka, Hans H. Schild, Carsten Meyer, Daniel Thomas, Julian A. Luetkens

Published in: European Radiology | Issue 9/2019

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Abstract

Objectives

To investigate the clinical potential of fat-free muscle area (FFMA) to predict outcome in patients with liver-predominant metastatic colorectal cancer (mCRC) undergoing radioembolization (RE) with 90Yttrium microspheres.

Methods

Patients with mCRC who underwent RE in our center were included in this retrospective study. All patients received liver magnetic resonance imaging including standard T2-weighted images. The total erector spinae muscle area and the intramuscular adipose tissue area were measured at the level of the origin of the superior mesenteric artery and subtracted to calculate FFMA. Cutoff values for definition of low FFMA were 3644 mm2 in men and 2825 mm2 in women. The main outcome was overall survival (OS). For survival analysis, the Kaplan-Meier method and Cox regressions comparing various clinic-oncological parameters which potentially may affect OS were performed.

Results

Seventy-seven patients (28 female, mean age 60 ± 11 years) were analyzed. Mean time between MRI and the following RE was 17 ± 31 days. Median OS after RE was 178 days. Patients with low FFMA had significantly shortened OS compared to patients with high FFMA (median OS: 128 vs. 273 days, p = 0.017). On multivariate Cox regression analysis, OS was best predicted by FFMA (hazard ratio (HR) 2.652; p < 0.001). Baseline bilirubin (HR 1.875; p = 0.030), pattern of tumor manifestation (HR 1.679; p = 0.001), and model of endstage liver disease (MELD) score (HR 1.164; p < 0.001) were also significantly associated with OS.

Conclusions

FFMA was associated with OS in patients receiving RE for treatment of mCRC and might be a new prognostic biomarker for survival prognosis.

Key Points

• Fat-free muscle area (FFMA) as a measure of lean muscle area predicts survival in metastatic colorectal liver cancer following radioembolization.
• FFMA can easily be assessed from routine pre-interventional liver magnetic resonance imaging.
• FFMA might be a new promising biomarker for assessment of sarcopenia.
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Metadata
Title
Fat-free muscle area measured by magnetic resonance imaging predicts overall survival of patients undergoing radioembolization of colorectal cancer liver metastases
Authors
Anton Faron
Claus C. Pieper
Frederic C. Schmeel
Alois M. Sprinkart
Daniel L. R. Kuetting
Rolf Fimmers
Jonel Trebicka
Hans H. Schild
Carsten Meyer
Daniel Thomas
Julian A. Luetkens
Publication date
01-09-2019
Publisher
Springer Berlin Heidelberg
Published in
European Radiology / Issue 9/2019
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI
https://doi.org/10.1007/s00330-018-5976-z

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