Cho Hye Jung, Kang Jeonghyun
Department of Surgery, Division of Colorectal Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
Ann Surg Treat Res. 2024 Jun;106(6):305-312. doi: 10.4174/astr.2024.106.6.305. Epub 2024 May 30.
Traditionally, cancer treatment has focused on the stages of the disease; however, recent studies have highlighted the importance of considering the overall health status of patients in the prognosis of cancer. Loss of skeletal muscle, known as sarcopenia, has been found to significantly affect outcomes in many different types of cancers, including colorectal cancer. In this review, we discuss the guidelines for diagnosing sarcopenia, with a specific focus on CT-based assessments. Many groups worldwide, including those in Europe and Asia, have introduced their own diagnostic guidelines for sarcopenia. Seemingly similar yet subtle discrepancies, particularly in the cutoff values used, limit the use of these guidelines in the general population, warranting a more universal guideline. Although CT-based measurements, such as skeletal muscle index and radiodensity, have shown promise in predicting outcomes, the lack of standardized values in these measurements hinders their universal adoption. To overcome these limitations, innovative approaches are being developed to assess changes in muscle mass trajectories and introduce new indices, such as skeletal and appendicular muscle gauges. Additionally, machine learning models have shown superior performance in predicting sarcopenic status, providing an alternative to CT-based diagnosis, particularly after surgery. CT has tremendous benefits and a significant role in visually as well as quantitatively retrieving information on patient body composition. In order to compensate for the limitation of standard cutoff value, 3-dimensional analysis of the CT, artificial intelligence-based body composition analysis, as well as machine learning algorithms for data interpretation and analysis have been proposed and are being utilized. In conclusion, despite the varying definitions of sarcopenia, CT-based measurements coupled with machine-learning models are promising for evaluating patients with cancer. Standardization efforts can improve diagnostic accuracy, reduce the reliance on CT examinations, and make sarcopenia assessments more accessible in clinical settings.
传统上,癌症治疗主要关注疾病的阶段;然而,最近的研究强调了在癌症预后中考虑患者整体健康状况的重要性。骨骼肌减少症,即骨骼肌的流失,已被发现会显著影响许多不同类型癌症的治疗结果,包括结直肠癌。在这篇综述中,我们讨论了诊断骨骼肌减少症的指南,特别关注基于CT的评估。包括欧洲和亚洲在内的全球许多组织都推出了自己的骨骼肌减少症诊断指南。看似相似但又细微的差异,尤其是在使用的临界值方面,限制了这些指南在普通人群中的应用,因此需要一个更通用的指南。尽管基于CT的测量,如骨骼肌指数和放射密度,在预测治疗结果方面显示出了前景,但这些测量缺乏标准化值阻碍了它们的广泛采用。为了克服这些限制,正在开发创新方法来评估肌肉质量轨迹的变化,并引入新的指标,如骨骼和附属肌肉测量值。此外,机器学习模型在预测骨骼肌减少症状态方面表现出了卓越性能,为基于CT的诊断提供了一种替代方法,尤其是在手术后。CT在直观以及定量获取患者身体成分信息方面具有巨大优势和重要作用。为了弥补标准临界值的局限性,已经提出并正在利用CT的三维分析、基于人工智能的身体成分分析以及用于数据解释和分析的机器学习算法。总之,尽管骨骼肌减少症的定义各不相同,但基于CT的测量与机器学习模型相结合在评估癌症患者方面很有前景。标准化努力可以提高诊断准确性,减少对CT检查的依赖,并使骨骼肌减少症评估在临床环境中更容易进行。