Explore the vast range of titles available.

IntroductionThe aim of the study was to extract anthropometric measures from CT by deep learning and to evaluate their prognostic value in patients with non-small-cell lung cancer (NSCLC).MethodsA convolutional neural network was trained to perform automatic segmentation of subcutaneous adipose tissue (SAT), visceral adipose tissue (VAT), and muscular body mass (MBM) from low-dose CT images in 189 patients with NSCLC who underwent pretherapy PET/CT. After a fivefold cross-validation in a subset of 35 patients, anthropometric measures extracted by deep learning were normalized to the body surface area (BSA) to control the various patient morphologies. VAT/SAT ratio and clinical parameters were included in a Cox proportional-hazards model for progression-free survival (PFS) and overall survival (OS).ResultsInference time for a whole volume was about 3 s. Mean Dice similarity coefficients in the validation set were 0.95, 0.93, and 0.91 for SAT, VAT, and MBM, respectively. For PFS prediction, T-stage, N-stage, chemotherapy, radiation therapy, and VAT/SAT ratio were associated with disease progression on univariate analysis. On multivariate analysis, only N-stage (HR = 1.7 [1.2–2.4]; p = 0.006), radiation therapy (HR = 2.4 [1.0–5.4]; p = 0.04), and VAT/SAT ratio (HR = 10.0 [2.7–37.9]; p < 0.001) remained significant prognosticators. For OS, male gender, smoking status, N-stage, a lower SAT/BSA ratio, and a higher VAT/SAT ratio were associated with mortality on univariate analysis. On multivariate analysis, male gender (HR = 2.8 [1.2–6.7]; p = 0.02), N-stage (HR = 2.1 [1.5–2.9]; p < 0.001), and the VAT/SAT ratio (HR = 7.9 [1.7–37.1]; p < 0.001) remained significant prognosticators.ConclusionThe BSA-normalized VAT/SAT ratio is an independent predictor of both PFS and OS in NSCLC patients.Key Points• Deep learning will make CT-derived anthropometric measures clinically usable as they are currently too time-consuming to calculate in routine practice.• Whole-body CT-derived anthropometrics in non-small-cell lung cancer are associated with progression-free survival and overall survival.• A priori medical knowledge can be implemented in the neural network loss function calculation.

Background A common method for diagnosing sarcopenia involves estimating the muscle mass by computed tomography (CT) via measurements of the cross‐sectional muscle area (CSMA) of all muscles at the third lumbar vertebra (L3) level. Recently, single‐muscle measurements of the psoas major muscle at L3 have emerged as a surrogate for sarcopenia detection, but its reliability and accuracy remain to be demonstrated. Methods This prospective cross‐sectional study involved 29 healthcare establishments and recruited patients with metastatic cancers. The correlation between skeletal muscle index (SMI = CSMA of all muscles at L3/height2, cm2/m2) and psoas muscle index (PMI = CSMA of psoas at L3/height2, cm2/m2) was determined (Pearson's r). ROC curves were prepared based on SMI data from a development population (n = 488) to estimate suitable PMI thresholds. International low SMI cut‐offs according to gender were studied for males (<55cm2/m2) and for females (<39 cm2/m2). Youden's index (J) and Cohen's kappa (κ) were calculated to estimate the test's accuracy and reliability. PMI cut‐offs were validated in a validation population (n = 243) by estimating the percentage concordance of sarcopenia diagnoses with the SMI thresholds. Results Seven hundred and sixty‐six patients were analysed (mean age 65.0 ± 11.8 years, 50.1% female). Low SMI prevalence was 69.1%. Correlation between the SMI and PMI for the entire population was 0.69 (n = 731, P < 0.01). PMI cut‐offs for sarcopenia were estimated in the development population at <6.6cm2/m2 in males and at <4.8 cm2/m2 for females. The J and κ coefficients for PMI diagnostic tests were weak. The PMI cut‐offs were tested in the validation population where 33.3% of the PMI measurements were dichotomously discordant. Conclusions A diagnostic test employing single‐muscle measurements of the psoas major muscle as a surrogate for sarcopenia detection was evaluated but found to be unreliable. The CSMA of all muscles must be considered for evaluating cancer sarcopenia at L3.

ObjectivesTo determine the degree of relationship between iodine concentrations derived from dual-energy CT (DECT) and perfusion CT parameters in patients with advanced HCC under treatment.MethodsIn this single-centre IRB approved study, 16 patients with advanced HCC treated with sorafenib or radioembolization who underwent concurrent dynamic perfusion CT and multiphase DECT using a single source, fast kV switching DECT scanner were included. Written informed consent was obtained for all patients. HCC late-arterial and portal iodine concentrations, blood flow (BF)-related and blood volume (BV)-related perfusion parameters maps were calculated. Mixed-effects models of the relationship between iodine concentrations and perfusion parameters were computed. An adjusted p value (Bonferroni method) < 0.05 was considered significant.ResultsMean HCC late-arterial and portal iodine concentrations were 22.7±12.7 mg/mL and 18.7±8.3 mg/mL, respectively. Late-arterial iodine concentration was significantly related to BV (mixed-effects model F statistic (F)=28.52, p<0.0001), arterial BF (aBF, F=17.62, p<0.0001), hepatic perfusion index (F=28.24, p<0.0001), positive enhancement integral (PEI, F=66.75, p<0.0001) and mean slope of increase (F=32.96, p<0.0001), while portal-venous iodine concentration was mainly related to BV (F=29.68, p<0.0001) and PEI (F=66.75, p<0.0001).ConclusionsIn advanced HCC lesions, DECT-derived late-arterial iodine concentration is strongly related to both aBF and BV, while portal iodine concentration mainly reflects BV, offering DECT the ability to evaluate both morphological and perfusion changes.Key points• Late-arterial iodine concentration is highly related to arterial BF and BV.• Portal iodine concentration mainly reflects tumour blood volume.• Dual-energy CT offers significantly decreased radiation dose compared with perfusion CT.

Background Patients with end‐stage renal disease may display both a loss of skeletal muscle mass and an increase in muscle fat deposits. We aimed to analyse the impact of low skeletal muscle mass index (SMI, surrogate marker of sarcopenia) and low muscle density (MD, surrogate marker of myosteatosis) on patient survival after kidney transplantation (KT). Methods In a retrospective cohort of 200 kidney transplant recipients (KTr), we measured on an unenhanced cross‐sectional computed tomography scan taken at the level of the third lumbar vertebra within the previous year or at the time of KT, both SMI (muscle cross‐sectional area normalized for height2, reported in cm2/m2) and MD (mean attenuation of muscle cross‐sectional area, expressed in Hounsfield units). We determined age‐specific and sex‐specific normality thresholds on 130 healthy subjects. The baseline factors associated with low MD were assessed by logistic regression analysis. Cox proportional hazard univariable and multivariable models were constructed to identify predictive factors of patient survival. Results Among the 200 patients of the cohort, 123 were male (62%), and mean age was 54.8 ± 13.8 years. A total of 181 KTr required renal replacement therapy before KT (91%), and 36 KTr (18%) received repeat kidney transplant after previous failed KT. Mean MD was 30.6 ± 9 HU in men and 29.7 ± 8.3 HU in women, whereas SMI was 49.7 ± 8.6 cm2/m2 in men and 42.3 ± 7.3 cm2/m2 in women. MD was below the 2.5th percentile for the healthy population in 49 KTr (25%), defining the myosteatosis group, while SMI was below the 2.5th percentile for the reference population in 10 KTr (5%). Independent risk factors for myosteatosis were two or more KT [adjusted odds ratio (aOR) 5.2, 95% confidence interval (95% CI): 2.22–12.4, P = 0.0001], a history of stroke (aOR 3.7, 95% CI: 1.30–10.7, P = 0.015), and body mass index > 25 kg/m2 (aOR 2.94, 95% CI: 1.4–6.18, P = 0.004). Myosteatosis was independently associated with mortality [adjusted hazard ratio (aHR) 2.12, 95% CI: 1.06–4.24, P = 0.033], as were cardiovascular disease (HR 2.06, 95% CI: 1.02–4.15, P = 0.043) and age (aHR 1.06, 95% CI: 1.03–1.09, P = 0.0003). Low SMI was not associated with mortality. Conclusions Myosteatosis, which was more prevalent than low skeletal muscle mass, might be an important prognostic marker in patients undergoing KT.

Background Advanced pancreatic ductal adenocarcinoma (aPDAC) is often accompanied by significant muscle mass loss, contributing to poor prognosis. SarcAPACaP, an ancillary study of the GERCOR‐APACaP phase III trial, evaluated the role of adapted physical activity (APA) in aPDAC Western patients receiving first‐line chemotherapy. The study aimed to assess (1) the potential impact of computed tomography (CT)–quantified muscle mass before and during treatments on health‐related quality of life (HRQoL) and overall survival (OS) and (2) the role of APA in mitigating muscle mass loss. Methods In the APACaP trial, aPDAC patients with ECOG performance status (PS) 0–2 were randomized 1:1 to usual care including first‐line chemotherapy or usual care plus a 16‐week home‐based APA program. In the SarcAPACaP study, the surface muscular index (SMI) was determined from L3 CT scan slices. Two patient populations were analysed: those with CT scan available at baseline (modified[m] intent‐to‐treat [ITT]1‐W0) and those with CT scans available at both W0 and W16 (mITT2 W0–W16). Low muscle mass was defined by low SMI with SMI < 41 cm2/m2 for women and < 43 and < 53 cm2/m2 for men with body max index < 25.0 and ≥ 25.0 kg/m2, respectively. Muscle loss was defined by the relative difference of SMI between W0 and W16 (100*[SMI W16–SMI W0]/SMI W0). In mITT2 W0–W16, patients were stratified into three groups based on the severity of muscle loss: none, moderate (0%–10%) and high (≥ 10%). Associations between muscle mass loss and OS, time until definitive deterioration (TUDD) of HRQoL and the effect of APA on loss of muscle mass were assessed. Results Between October 2014 and May 2020, 313 patients were prospectively enrolled, with 225 in mITT1 W0 and 128 in mITT2 W0–W16, with 65 assigned to the APA arm. Both groups had similar baseline characteristics with comparable OS and TUDD. A low SMI at W0 was not associated with OS and TUDD of HRQoL in either group. Among mITT2 W0–W16 patients, high muscle mass loss (n = 27) independently predicted OS (p = 0.012) and showed a trend toward negatively affecting TUDD of HRQoL. Notably, APA did not mitigate muscle loss in our study population. Conclusions Longitudinal muscle mass loss emerged as a predictive factor for both OS and HRQoL in aPDAC patients undergoing chemotherapy, while a low SMI at diagnosis did not provide prognostic value. APA did not impact muscle mass loss in this population.

Cancer cachexia occurs in patients with far advanced disease. It is known to be a prognostic factor for poor survival and is almost impossible to reverse. Therefore, early detection and prevention are essential. Sarcopenia, usually based in oncology on skeletal muscle mass loss, is a component of cachexia and an independent prognostic factor for the efficacy and toxicity of cancer therapies and a negative predictor for survival. Using CT to measure the muscular surface area at the third lumbar, vertebra (L3) section is of great interest in low skeletal muscle mass (LSMM) detection.

Introduction Being one of the most practiced procedures in plastic surgery, it is important to foster a better understanding of the effect of anatomical changes in the pubic area after abdominoplasty on sexuality in women. Since to date no study has been performed with this purpose, our aim is to evaluate the impact of the abdominoplasty on sexual pleasure and to perform an objective evaluation of changes in clitoral position and prepubic fat area after this procedure. Materials and Methods A prospective study has been performed in 50 women who expressed a desire to undergo abdominoplasty from January 2021 to December 2021. The primary endpoint was Sexual pleasure assessed by the \"Sexuality Assessment Scale\" before and 6 months after abdominoplasty in all patients. Furthermore, we evaluated the physical changes of the clitoris (clito-pubic distance, CP distance) and the prepubic fat area on magnetic resonance imaging before and 3 months after abdominoplasty. Results Patients mean age was of 42 ± 9 years, and mean body mass index of 26 ± 2 kg/m 2 . A significant difference ( P < 0.0001) between sexual satisfaction before and 6 months after abdominoplasty (mean difference +7.4 ± 6.452) was found. Though there was no significant difference between the clito-pubic distance before and after abdominoplasty (mean difference −3.200 ± 2.499 mm; p = 0.0832), a significant difference was found in the size of the prepubic fat area before compared to after abdominoplasty (mean difference −1.714 ± 1.010 cm 2 ; p = 0.0426). However, no significant relationship between these anatomical changes and sexual satisfaction was found. Conclusion Our results show that abdominoplasty is associated with an increase in sexual satisfaction. The changes in the post-operative position of the clitoris were not statistically significant, contrarily to the size of the prepubic fat area, which was significantly modified and could partially explain the improved sexual pleasure. Authors were unable to statistically demonstrate a correlation between those anatomical modifications and sexual pleasure. Level of Evidence IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Background Computed tomography (CT) scan–defined myosteatosis is a common feature in ESKD patients receiving kidney transplantation (KT) and is associated with mortality after KT. We aimed to explore the impact of myosteatosis and other CT scan based morphometric data on the occurrence of early surgical complications after KT. Methods We retrospectively measured on an unenhanced cross‐sectional CT scan taken at the middle of the third lumbar vertebra performed within the previous year or at the time of KT: surface muscle index (total lumbar cross‐sectional muscle area [CSMA] divided by height squared), subcutaneaous adipose tissue index, visceral adipose tissue index and muscle density (MD: mean CT attenuation of CSMA). Vessel to skin distance was the distance between iliac vein and skin. Myosteatosis was defined as MD below age‐ and sex‐specific normal values. Logistic regression models were constructed to identify predictive factor of 90 days postoperative surgical complications with Clavien–Dindo score greater than or equal to 2, CD ≥ 2). Results Among the N = 200 patients, 61.5% were male with a mean age of 54.8 (± 13.8) years and a mean BMI of 25.1 (± 4.4) kg/m2. Sixty patients (30%) developed at least one postoperative complication (CD ≥ 2) in the first 3 months after KT. In two different multivariate analyses, MD (aOR: 0.95 for one Hounsfield unit increase, 95% CI: 0.91–0.99, p = 0.028) and myosteatosis status (aOR: 4.64, 95% CI: 2.18–9.90, p < 0.0001) were the only independent risk factors for postsurgical complication. Conclusions Myosteatosis is independently associated with the occurrence of CD ≥ 2 postoperative complication within 90 days of surgery.

BackgroundSarcopenia and growth differentiation factor 15 (GDF-15) are linked to poor cancer survival. In this exploratory analysis, we evaluated their interaction with nivolumab-ipilimumab efficacy in chemoresistant metastatic colorectal cancer (mCRC) harboring microsatellite instability and/or mismatch-repair deficiency (MSI/dMMR), based on the final survival analysis of the NIPICOL phase II trial.Patients and methods57 patients with MSI/dMMR chemoresistant mCRC received nivolumab-ipilimumab for 3 months (3M), then, nivolumab alone for 9M. Skeletal muscle mass index (SMI) was evaluated by CT scan at baseline and 12M to assess sarcopenia. GDF-15 levels were assessed at baseline and 3M. Main endpoints were overall survival (OS) and immune Response Evaluation Criteria In Solid Tumors progression-free survival (iPFS).ResultsAfter excluding three patients not confirmed as MSI/dMMR by central review, the overall median follow-up was 60.4 months. The 3-year and 5 year iPFS rates were 72.0% and 65.3%, with OS rates of 77.5% and 73.3%, respectively. Among 49 patients with evaluable GDF-15, high-baseline GDF-15 was associated with poorer survival: 3-year iPFS rate of 56.3% for GDF-15≥2500 versus 81.7% for GDF-15<2500 (PFS HR=2.45, 95% CI 0.91 to 6.55), 3-year OS rates of 61.4% versus 84.5% (OS HR=2.08, 95% CI 0.70 to 6.22). Of the 48 evaluable patients for SMI, 31 (65.0%) displayed sarcopenia at baseline. 11 out of 20 (55%) patients with baseline sarcopenia and assessed for SMI at 12M, reversed sarcopenia by 12M. They had higher baseline GDF-15 levels and greater GDF-15 decrease by 3M (delta mean change: −69.8% vs −40.3%) compared with patients who remained sarcopenic.Conclusion1-year nivolumab-ipilimumab demonstrates consistent efficacy after 5-year follow-up in an MSI/dMMR chemoresistant mCRC population. GDF-15 confirms to be a promising biomarker for sarcopenia and survival.Trial registration number NCT03350126.