Centre for Physical Activity Research (CFAS), Rigshospitalet, University of Copenhagen, Blegdamsvej 9, DK-2100 Copenhagen, Denmark.
Department of Radiology, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, DK-2100 Copenhagen, Denmark.
Clin Nutr. 2021 May;40(5):2809-2816. doi: 10.1016/j.clnu.2021.03.022. Epub 2021 Mar 26.
BACKGROUND & AIMS: Sarcopenia is associated with an increased risk of complications to treatment and lower survival rates in patients with cancer, but there is a lack of agreement on cut-off values and assessment methods. We aimed to investigate the prevalence of sarcopenia assessed by dual-energy x-ray absorptiometry (DXA) and computed tomography (CT) as well as the agreement between the methods for identification of sarcopenia.
This cross-sectional study pooled data from two studies including patients scheduled for surgery for gastrointestinal tumors. We assessed sarcopenia using two different cut-off values derived from healthy young adults for DXA and two for CT. Additionally, we used one of the most widely applied cut-off values for CT assessed sarcopenia derived from obese cancer patients. The agreement between DXA and CT was evaluated using Cohen's kappa. The mean difference and range of agreement between DXA and CT for estimating total and appendicular lean soft tissue were assessed using Bland-Altman plots.
In total, 131 patients were included. With DXA the prevalence of sarcopenia was 11.5% and 19.1%. Using CT, the prevalence of sarcopenia was 3.8% and 26.7% using cut-off values from healthy young adults and 64.1% using the widely applied cut-off value. The agreement between DXA and CT in identifying sarcopenia was poor, with Cohen's kappa values ranging from 0.05 to 0.39. The mean difference for estimated total lean soft tissue was 1.4 kg, with 95% limits of agreement from -8.6 to 11.5 kg. For appendicular lean soft tissue, the ratio between DXA and CT was 1.15, with 95% limits of agreement from 0.92 to 1.44.
The prevalence of sarcopenia defined using DXA and CT varied substantially, and the agreement between the two modalities is poor.
肌肉减少症与癌症患者治疗并发症风险增加和生存率降低相关，但目前对于其截断值和评估方法尚未达成共识。本研究旨在通过双能 X 射线吸收法（DXA）和计算机断层扫描（CT）评估肌肉减少症的患病率，并探讨这两种方法识别肌肉减少症的一致性。
本横断面研究汇集了两项研究的数据，研究对象为计划接受胃肠道肿瘤手术的患者。我们使用两种不同的截断值评估 DXA 和 CT 检测的肌肉减少症，这两种截断值来自健康的年轻成年人。此外，我们还使用了一种最常用于评估肥胖癌症患者的 CT 检测肌肉减少症的截断值。采用 Cohen's kappa 评估 DXA 和 CT 之间的一致性。采用 Bland-Altman 图评估 DXA 和 CT 估计全身和四肢瘦软组织的平均差异和一致性范围。
共纳入 131 例患者。DXA 检测肌肉减少症的患病率为 11.5%和 19.1%，而 CT 检测肌肉减少症的患病率为 3.8%和 26.7%，其中健康的年轻成年人的截断值为 26.7%，广泛应用的截断值为 64.1%。DXA 和 CT 识别肌肉减少症的一致性较差，Cohen's kappa 值范围为 0.05-0.39。估计全身瘦软组织的平均差异为 1.4kg，95%一致性界限为-8.6 至 11.5kg。对于四肢瘦软组织，DXA 和 CT 的比值为 1.15，95%一致性界限为 0.92 至 1.44。
DXA 和 CT 定义的肌肉减少症患病率差异较大，两种方法之间的一致性较差。
