Correspondence
Sarcopenia Is More Than Simply Documenting Low Skeletal Muscle Mass As elderly patients have increasingly been admitted to surgery due to medical advances, conditions (but not socalled diseases) such as sarcopenia, frailty, and delirium have emerged as novel measures of perioperative and postoperative morbidity and mortality. In a recent article in Cancer, Psutka et al reported sarcopenia to be a predictor of cancer-specific survival and all-cause mortality after radical cystectomy, which is a major treatment option for patients with bladder cancer. The authors concluded that the assessment of sarcopenia prior to bladder surgery by computed tomography (CT) scan (L3 muscle index) was helpful in predicting survival after radical cystectomy.1 Although this is an important finding, the methods used to test the outcome measures may be argued against based on the current recommendations to define sarcopenia, which is no longer known as simple loss of muscle mass due to ageing. It was only within the past few years that the European Society for Clinical Nutrition and Metabolism, the International Academy on Nutrition and Aging, and the International Association of Gerontology and Geriatrics for the European Region started working collaboratively to reach a consensus for diagnostic criteria for age-related sarcopenia.2 This consensus report defined sarcopenia as the presence of low muscle mass plus low muscle function (muscle strength or physical performance).2 Moreover, the presence of low muscle mass with preserved function, which is a common clinical condition, was defined as “presarcopenia.”2 Therefore, estimation of muscle function is very important in making the diagnosis of sarcopenia. In this context, the probable misclassification of subjects with “presarcopenia” as being sarcopenic cannot be ignored in the study by Psutka et al,1 and might require further verifications. Second, although CT and magnetic resonance imaging are the 2 gold standard options for measuring muscle mass, validation of single-slice CT to define muscle mass, which was the only tool used in the study by Psutka et al,1 was assessed only by comparing with dual-energy x-ray absorptiometry, which is not regarded a good standard technique.2-4 FUNDING SUPPORT No specific funding was disclosed.
Cancer
January 1, 2015
CONFLICT OF INTEREST DISCLOSURES The authors made no disclosures.
REFERENCES 1. Psutka SP, Carrasco A, Schmit GD, et al. Sarcopenia in patients with bladder cancer undergoing radical cystectomy: impact on cancerspecific and all-cause mortality [published online ahead of print May 19, 2014]. Cancer. doi: 10.1002/cncr.28798. 2. Cruz-Jentoft AJ, Baeyens JP, Bauer JM, et al; European Working Group on Sarcopenia in Older People. Sarcopenia: European consensus on definition and diagnosis: report of the European Working Group on Sarcopenia in Older People. Age Ageing. 2010;39:412-423. 3. Binay Safer V, Safer U. Usefulness and limitations of single-slice computed tomography analysis at the third lumbar region in the assessment of sarcopenia. Crit Care. 2013;20;17:466. 4. Safer U, Binay Safer V. Could single-slice quantitative computerized tomography image analysis at the midpoint of the third lumbar region accurately predict total body skeletal muscle? JPEN J Parenter Enteral Nutr. 2014;38:415.
Umit Cintosun, MD Department of Geriatrics Gulhane School of Medicine Ankara, Turkey
Ilker Tasci, MD Department of Internal Medicine Gulhane School of Medicine Ankara, Turkey
Vildan Binay Safer, MD Department of Physical Medicine and Rehabilitation Ankara Physical Medicine and Rehabilitation Research and Training Hospital Ankara, Turkey
Umut Safer, MD Department of Geriatrics Gulhane School of Medicine Ankara, Turkey DOI: 10.1002/cncr.29016, Published online September 10, 2014 in Wiley Online Library (wileyonlinelibrary.com)
Reply to Sarcopenia Is More Than Simply Documenting Low Skeletal Muscle Mass We thank Dr. Clintosun and colleagues for their interest in our study.1 They are accurate in pointing out that the European Working Group on Sarcopenia in Older People (EWGSOP) defined sarcopenia as a loss of muscle mass and low muscle strength or low physical performance.2 The lack of information regarding strength and performance is an acknowledged limitation of our study. Yet one would expect that if some patients with low muscle mass and preserved muscle function were inappropriately classified as sarcopenic in our study, the effect would be even greater than we determined. Furthermore, multiple definitions of the term “sarcopenia” remain in use in the 159
Copyright of Cancer (0008543X) is the property of John Wiley & Sons, Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
Sarcopenia Is More Than Simply Documenting Low Skeletal Muscle Mass As elderly patients have increasingly been admitted to surgery due to medical advances, conditions (but not socalled diseases) such as sarcopenia, frailty, and delirium have emerged as novel measures of perioperative and postoperative morbidity and mortality. In a recent article in Cancer, Psutka et al reported sarcopenia to be a predictor of cancer-specific survival and all-cause mortality after radical cystectomy, which is a major treatment option for patients with bladder cancer. The authors concluded that the assessment of sarcopenia prior to bladder surgery by computed tomography (CT) scan (L3 muscle index) was helpful in predicting survival after radical cystectomy.1 Although this is an important finding, the methods used to test the outcome measures may be argued against based on the current recommendations to define sarcopenia, which is no longer known as simple loss of muscle mass due to ageing. It was only within the past few years that the European Society for Clinical Nutrition and Metabolism, the International Academy on Nutrition and Aging, and the International Association of Gerontology and Geriatrics for the European Region started working collaboratively to reach a consensus for diagnostic criteria for age-related sarcopenia.2 This consensus report defined sarcopenia as the presence of low muscle mass plus low muscle function (muscle strength or physical performance).2 Moreover, the presence of low muscle mass with preserved function, which is a common clinical condition, was defined as “presarcopenia.”2 Therefore, estimation of muscle function is very important in making the diagnosis of sarcopenia. In this context, the probable misclassification of subjects with “presarcopenia” as being sarcopenic cannot be ignored in the study by Psutka et al,1 and might require further verifications. Second, although CT and magnetic resonance imaging are the 2 gold standard options for measuring muscle mass, validation of single-slice CT to define muscle mass, which was the only tool used in the study by Psutka et al,1 was assessed only by comparing with dual-energy x-ray absorptiometry, which is not regarded a good standard technique.2-4 FUNDING SUPPORT No specific funding was disclosed.
Cancer
January 1, 2015
CONFLICT OF INTEREST DISCLOSURES The authors made no disclosures.
REFERENCES 1. Psutka SP, Carrasco A, Schmit GD, et al. Sarcopenia in patients with bladder cancer undergoing radical cystectomy: impact on cancerspecific and all-cause mortality [published online ahead of print May 19, 2014]. Cancer. doi: 10.1002/cncr.28798. 2. Cruz-Jentoft AJ, Baeyens JP, Bauer JM, et al; European Working Group on Sarcopenia in Older People. Sarcopenia: European consensus on definition and diagnosis: report of the European Working Group on Sarcopenia in Older People. Age Ageing. 2010;39:412-423. 3. Binay Safer V, Safer U. Usefulness and limitations of single-slice computed tomography analysis at the third lumbar region in the assessment of sarcopenia. Crit Care. 2013;20;17:466. 4. Safer U, Binay Safer V. Could single-slice quantitative computerized tomography image analysis at the midpoint of the third lumbar region accurately predict total body skeletal muscle? JPEN J Parenter Enteral Nutr. 2014;38:415.
Umit Cintosun, MD Department of Geriatrics Gulhane School of Medicine Ankara, Turkey
Ilker Tasci, MD Department of Internal Medicine Gulhane School of Medicine Ankara, Turkey
Vildan Binay Safer, MD Department of Physical Medicine and Rehabilitation Ankara Physical Medicine and Rehabilitation Research and Training Hospital Ankara, Turkey
Umut Safer, MD Department of Geriatrics Gulhane School of Medicine Ankara, Turkey DOI: 10.1002/cncr.29016, Published online September 10, 2014 in Wiley Online Library (wileyonlinelibrary.com)
Reply to Sarcopenia Is More Than Simply Documenting Low Skeletal Muscle Mass We thank Dr. Clintosun and colleagues for their interest in our study.1 They are accurate in pointing out that the European Working Group on Sarcopenia in Older People (EWGSOP) defined sarcopenia as a loss of muscle mass and low muscle strength or low physical performance.2 The lack of information regarding strength and performance is an acknowledged limitation of our study. Yet one would expect that if some patients with low muscle mass and preserved muscle function were inappropriately classified as sarcopenic in our study, the effect would be even greater than we determined. Furthermore, multiple definitions of the term “sarcopenia” remain in use in the 159
Copyright of Cancer (0008543X) is the property of John Wiley & Sons, Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
