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. 2025 Mar;16(2):102171.
doi: 10.1016/j.jgo.2024.102171. Epub 2024 Dec 14.

Computed tomography-determined high visceral adipose tissue and sarcopenic obesity and their associations with survival in vulnerable or frail older adults with cancer considered for systemic anticancer treatment

Antti Tolonen  1 , Kaisa Lehtomäki  2 , Hanna Kerminen  3 , Heini Huhtala  4 , Maarit Bärlund  5 , Pia Österlund  6 , Otso Arponen  7
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Free article

Computed tomography-determined high visceral adipose tissue and sarcopenic obesity and their associations with survival in vulnerable or frail older adults with cancer considered for systemic anticancer treatment

Antti Tolonen et al. J Geriatr Oncol. 2025 Mar.
Free article

Abstract

Introduction: Treatment decisions are challenging in older adults with solid tumors. Geriatric 8 (G8)-screening and comprehensive geriatric assessment (CGA) are important but additional methods are needed. We examined the association of computed tomography (CT)-derived high visceral adipose tissue index (VATI) with or without low skeletal muscle index (SMI) on three-month and overall survival (OS).

Materials and methods: Vulnerability was evaluated with G8 in patients ≥75 years referred for systemic anticancer treatment. Vulnerable/frail patients (G8 ≤ 14) received CGA and were included. VATI and SMI were retrospectively measured from CT scans. We examined associations between high VATI with or without low SMI and three-month and OS with Cox regression models and Kaplan-Meier estimation.

Results: Seventy-nine patients with median age of 80 (range 75-91) years were evaluated. In the palliative-intent group (n = 58), three-month OS rates were 88 % and 58 % in the normal and high VATI groups, respectively (hazard ratio 4.3; 95 % confidence interval 1.3-14), and 88 % vs. 47 % in group without and with 'high VATI+low SMI', respectively (5.5; 1.9-17). The median OS was 12.7 vs. 9.5 months in normal VATI/SMI and 'high VATI+low SMI' (1.9; 1.1-3.2), respectively. In Cox multivariable models with established predictive factors (ECOG PS, Clinical Frailty Scale, and sex), only high VATI (4.9; 1.0-24) or 'high VATI+low SMI' (8.9; 1.7-46) remained significant predictors of three-month OS.

Discussion: High VATI with or without low SMI were associated with impaired three-month OS in the palliative-intent group and with OS in the whole cohort independently of oncologic and geriatric functional status measures; thus, they may aid in treatment decision-making.

Keywords: Body composition; Computed tomography; Frailty; Older adults; Sarcopenia; Sarcopenic obesity; cachexia.

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Conflict of interest statement

Declaration of Competing Interest The authors declare that they have no conflicts of interest. The funders had no role in the design of the study, in the collection, analyses or interpretation of data, in the writing of the manuscript, or in the decision to publish the results. Additionally, O.A. received grants from the Osk. Huttunen Foundation, Sigrid Jusélius Foundation, Relander Foundation, Finnish Medical Foundation, Cancer Foundation Finland, and Orion Research Foundation.

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