Bjørn H Grønberg1,2, Bjørg Sjøblom3, Tore Wentzel-Larsen4,5,6, Vickie E Baracos7, Marianne J Hjermstad8,9, Nina Aass3,8, Roy M Bremnes10,11, Øystein Fløtten12, Asta Bye9,13, Marit Jordhøy8,14. 1. Faculty of Medicine, Department of Clinical and Molecular Medicine, NTNU, Norwegian University of Science and Technology, Trondheim, Norway. bjorn.h.gronberg@gmail.com. 2. The Cancer Clinic, St. Olav's Hospital, Trondheim University Hospital, Trondheim, Norway. bjorn.h.gronberg@gmail.com. 3. Department of Oncology, Oslo University Hospital, Oslo, Norway. 4. Norwegian Centre for Violence and Traumatic Stress Studies, Oslo, Norway. 5. Centre for Child and Adolescent Mental Health, Eastern and Southern Norway, Oslo, Norway. 6. Centre for Clinical Research, Haukeland University Hospital, Bergen, Norway. 7. Division of Palliative Care Medicine, Department of Oncology, University of Alberta, Edmonton, Canada. 8. Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway. 9. Department of Oncology, European Palliative Care Research Centre, Oslo University Hospital, Oslo, Norway. 10. Department of Oncology, University Hospital of North Norway, Tromsø, Norway. 11. Faculty of Medicine, Department of Clinical Medicine, UiT - The Arctic University of Norway, Tromsø, Norway. 12. Department of Thoracic Medicine, Haukeland University Hospital, Bergen, Norway. 13. Faculty of Health Sciences, Department of Nursing and Health Promotion, Oslo Metropolitan University, Oslo, Norway. 14. Department of Internal Medicine, Innlandet Hospital Trust, Hamar, Norway.
Abstract
BACKGROUND: Muscle mass and density assessed from CT-images at the L3 level are prognostic for survival and predict toxicity in cancer patients. However, L3 is not always included on routine CT-scans. We aimed to investigate whether images at the Th4 level may be used instead. METHODS: Patients from three chemotherapy trials in advanced NSCLC were eligible (n = 1305). Skeletal muscle area (cm2), skeletal muscle index (SMI, cm2/m2) and skeletal muscle density (SMD) at Th4 and L3 levels were assessed from baseline CT-scans. SMI and SMD at the Th4 and L3 level were transformed into z-scores and the agreement between scores was investigated by Bland-Altman plots and estimated by intra-class correlation analyses. Linear regression was used to test if Th4 SMI and SMD z-scores predicted L3 SMI and SMD z-scores. RESULTS: CT-images from 401 patients were analysable at both levels. There was a moderate agreement between Th4 and L3 SMI z-scores with an intra-class correlation of 0.71 (95% CI 0.64-0.77) for men and 0.53 (95% CI 0.41-0.63) for women. Regression models predicting L3 SMI z-scores from Th4 SMI z-scores showed coefficients of 0.71 (95% CI 0.62-0.80) among men and 0.53 (95% CI 0.40-0.66) among women. R-squares were 0.51 and 0.28, respectively, indicating moderate agreement. A similar, moderate agreement between Th4 and L3 SMD z-scores was observed. CONCLUSION: There was only moderate agreement between muscle measures from Th4 and L3 levels, indicating that missing data from the L3 level cannot be replaced by analysing images at the Th4 level.
BACKGROUND: Muscle mass and density assessed from CT-images at the L3 level are prognostic for survival and predict toxicity in cancerpatients. However, L3 is not always included on routine CT-scans. We aimed to investigate whether images at the Th4 level may be used instead. METHODS:Patients from three chemotherapy trials in advanced NSCLC were eligible (n = 1305). Skeletal muscle area (cm2), skeletal muscle index (SMI, cm2/m2) and skeletal muscle density (SMD) at Th4 and L3 levels were assessed from baseline CT-scans. SMI and SMD at the Th4 and L3 level were transformed into z-scores and the agreement between scores was investigated by Bland-Altman plots and estimated by intra-class correlation analyses. Linear regression was used to test if Th4 SMI and SMD z-scores predicted L3 SMI and SMD z-scores. RESULTS: CT-images from 401 patients were analysable at both levels. There was a moderate agreement between Th4 and L3 SMI z-scores with an intra-class correlation of 0.71 (95% CI 0.64-0.77) for men and 0.53 (95% CI 0.41-0.63) for women. Regression models predicting L3 SMI z-scores from Th4 SMI z-scores showed coefficients of 0.71 (95% CI 0.62-0.80) among men and 0.53 (95% CI 0.40-0.66) among women. R-squares were 0.51 and 0.28, respectively, indicating moderate agreement. A similar, moderate agreement between Th4 and L3 SMD z-scores was observed. CONCLUSION: There was only moderate agreement between muscle measures from Th4 and L3 levels, indicating that missing data from the L3 level cannot be replaced by analysing images at the Th4 level.
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