Pediatric SurgeryThe Influence of Sarcopenia on High-Risk Neuroblastoma
Introduction
Neuroblastoma is the most common solid malignant extracranial tumor in children. Despite the enormous amount of basic and clinical research that has been conducted on the topic of this disease entity, patients with unfavorable prognostic factors show a poor prognosis.1, 2 Patients with neuroblastoma, especially those with high-risk disease, are commonly treated with chemotherapy, stem cell transplantation, radiotherapy, and surgery.
Several factors are associated with a poor prognosis in neuroblastoma, including an onset in children of >1.5 y of age, MYCN amplification, DNA diploid, pooled segmental chromosomal aberrations and gain of 17q and segmental chromosomal aberrations at 11q.3 A recent study revealed that a germline mutation of ALK was responsible for most familial neuroblastoma.4 Telomerase reverse transcriptase gene (TERT) rearrangement was observed in high-risk neuroblastoma and was correlated with a poor prognosis.5
Sarcopenia is a syndrome that is defined by the loss of skeletal muscle mass, quality, and strength.6 Sarcopenia is closely related to decreased muscle mass; this can be evaluated by computed tomography (CT), which enables the precise quantification of the skeletal muscle volume.7, 8 In adult patients with malignancies, the presence of sarcopenia before surgery is known to be correlated with a high rate of postoperative morbidity and a poor prognosis9, 10, 11, 12, 13; however, there have been no reports on the influence of sarcopenia on malignant solid tumors in pediatric patients. There have been a few reports about sarcopenia in patients with acute lymphoid leukemia.14, 15 These reports showed that the skeletal muscle mass of the patients with this disease decreased during chemotherapy.
We hypothesized that the skeletal muscle mass of high-risk neuroblastoma patients would decrease during a series of treatments and would predict a prognosis. In the present study, we investigated whether or not sarcopenia affects the prognosis of high-risk neuroblastoma.
Section snippets
Patients
Fifteen patients with high-risk neuroblastoma who were treated according to the standard protocol at our hospital from 2007 to 2016 were included in this study. Two patients whose CT images were not available were excluded. During this period, 54 neuroblastoma patients were treated in our hospital. High-risk neuroblastoma was defined according to the patient's age, International Neuroblastoma Staging System disease stage, MYCN status, and other biological features; the protocol was identical to
Results
As shown in Table 1, the age, gender, presence of MYCN amplification, DNA ploidy, Shimada classification, and NLR at the diagnosis did not differ markedly between the two groups. Next, we compared the rate of change in the PMA during standard treatment, the Kaup index, and the serum albumin level. Significant differences were observed between the rates of change in the PMA in the PFS (1.24) and R/D (0.84) groups (P = 0.0472). By contrast, the rate of change in the Kaup index and the serum
Discussion
Sarcopenia is a syndrome that is defined by the progressive and generalized loss of skeletal muscle mass and strength. The European Working Group on Sarcopenia in Older People recommended using the presence of both a low muscle mass and low muscle function (strength or performance) to diagnose sarcopenia. A low muscle mass is calculated based on CT, magnetic resonance imaging, or dual-energy X-ray absorptiometry findings. Other tools (e.g., a bioimpedance analysis or the total or partial body
Acknowledgment
The authors thank Brian Quinn (Editor-in-Chief, Japan Medical Communication, Inc., Fukuoka, Japan) for his assistance in the reading and editing of the English of this article.
Authors' contributions: N.K. and Y.K. participated in the design, data analysis, research, and writing of the article; R.S., Yu.K., U.O., and S.O. provided helpful advice; T.T. reviewed the article and supervised the whole study process.
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Ethical approval: The Institutional Review Board of Kyushu University approved this study. This retrospective study was performed according to the Ethical Guidelines for Clinical Research, published by the Ministry of Health, Labor and Welfare, Japan on July 30, 2003 (revised in 2008). The study complied with the 1964 Declaration of Helsinki (revised in 2008).