Machine learning–based detection of sarcopenic obesity and association with adverse outcomes in patients undergoing surgical treatment for spinal metastases

Presented at the 2023 AANS/CNS Joint Section on Disorders of the Spine and Peripheral Nerves

Syed I. Khalid Departments of Neurosurgery and
Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois;

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Elie Massaad Departments of Neurosurgery and

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 MD, MSc
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Ali Kiapour Departments of Neurosurgery and

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Christopher P. Bridge Massachusetts General Hospital and Brigham and Women’s Hospital Center for Clinical Data Science, Boston, Massachusetts;

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Grant Rigney Departments of Neurosurgery and

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Akeive Burrows Departments of Neurosurgery and

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Jane Shim Departments of Neurosurgery and

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Rafael De la Garza Ramos Department of Neurosurgery, The Warren Alpert Medical School of Brown University, Providence, Rhode Island; and

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Daniel G. Tobert Orthopedic Surgery, Massachusetts General Hospital, Boston, Massachusetts;

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Andrew J. Schoenfeld Department of Orthopedic Surgery, Brigham and Women’s Hospital, Boston, Massachusetts

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Theresa Williamson Departments of Neurosurgery and

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Ganesh M. Shankar Departments of Neurosurgery and

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John H. Shin Departments of Neurosurgery and

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OBJECTIVE

The distributions and proportions of lean and fat tissues may help better assess the prognosis and outcomes of patients with spinal metastases. Specifically, in obese patients, sarcopenia may be easily overlooked as a poor prognostic indicator. The role of this body phenotype, sarcopenic obesity (SO), has not been adequately studied among patients undergoing surgical treatment for spinal metastases. To this end, here the authors investigated the role of SO as a potential prognostic factor in patients undergoing surgical treatment for spinal metastases.

METHODS

The authors identified patients who underwent surgical treatment for spinal metastases between 2010 and 2020. A validated deep learning approach evaluated sarcopenia and adiposity on routine preoperative CT images. Based on composition analyses, patients were classified with SO or nonsarcopenic obesity. After nearest-neighbor propensity matching that accounted for confounders, the authors compared the rates and odds of postoperative complications, length of stay, 30-day readmission, and all-cause mortality at 90 days and 1 year between the SO and nonsarcopenic obesity groups.

RESULTS

A total of 62 patients with obesity underwent surgical treatment for spinal metastases during the study period. Of these, 37 patients had nonsarcopenic obesity and 25 had SO. After propensity matching, 50 records were evaluated that were equally composed of patients with nonsarcopenic obesity and SO (25 patients each). Patients with SO were noted to have increased odds of nonhome discharge (OR 6.0, 95% CI 1.69–21.26), 30-day readmission (OR 3.27, 95% CI 1.01–10.62), and 90-day (OR 4.85, 95% CI 1.29–18.26) and 1-year (OR 3.78, 95% CI 1.17–12.19) mortality, as well as increased time to mortality after surgery (12.60 ± 19.84 months vs 37.16 ± 35.19 months, p = 0.002; standardized mean difference 0.86). No significant differences were noted in terms of length of stay or postoperative complications when comparing the two groups (p > 0.05).

CONCLUSIONS

The SO phenotype was associated with increased odds of nonhome discharge, readmission, and postoperative mortality. This study suggests that SO may be an important prognostic factor to consider when developing care plans for patients with spinal metastases.

ABBREVIATIONS

DVT = deep vein thrombosis; GU = genitourinary; mFI-5 = modified 5-item frailty index; MSTFI = metastatic spinal tumor frailty index; PE = pulmonary embolism; SMD = standardized mean difference; SO = sarcopenic obesity; UTI = urinary tract infection; XRT = radiation-based intervention.

Supplementary Materials

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Images from Özer and Demirtaş (pp 351–358).
  • 1

    Xiong GX, Fisher MWA, Schwab JH, et al. A natural history of patients treated operatively and nonoperatively for spinal metastases over 2 years following treatment: survival and functional outcomes. Spine (Phila Pa 1976). 2022;47(7):515522.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 2

    Luksanapruksa P, Buchowski JM, Hotchkiss W, Tongsai S, Wilartratsami S, Chotivichit A. Prognostic factors in patients with spinal metastasis: a systematic review and meta-analysis. Spine J. 2017;17(5):689708.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 3

    Del Fabbro E, Parsons H, Warneke CL, et al. The relationship between body composition and response to neoadjuvant chemotherapy in women with operable breast cancer. Oncologist. 2012;17(10):12401245.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 4

    Petrelli F, Cortellini A, Indini A, et al. Association of obesity with survival outcomes in patients with cancer: a systematic review and meta-analysis. JAMA Netw Open. 2021;4(3):e213520.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 5

    Aune D, Sen A, Prasad M, et al. BMI and all cause mortality: systematic review and non-linear dose-response meta-analysis of 230 cohort studies with 3.74 million deaths among 30.3 million participants. BMJ. 2016;353:i2156.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 6

    Calle EE, Rodriguez C, Walker-Thurmond K, Thun MJ. Overweight, obesity, and mortality from cancer in a prospectively studied cohort of U.S. adults. N Engl J Med. 2003;348(17):16251638.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 7

    Du Bois D, Du Bois EF. A formula to estimate the approximate surface area if height and weight be known. 1916.Nutrition. 1989;5(5):303313.

  • 8

    Rier HN, Jager A, Sleijfer S, Maier AB, Levin MD. The prevalence and prognostic value of low muscle mass in cancer patients: a review of the literature. Oncologist. 2016;21(11):13961409.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 9

    Cushen SJ, Power DG, Murphy KP, et al. Impact of body composition parameters on clinical outcomes in patients with metastatic castrate-resistant prostate cancer treated with docetaxel. Clin Nutr ESPEN. 2016;13:e39e45.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 10

    Sandini M, Bernasconi DP, Fior D, et al. A high visceral adipose tissue-to-skeletal muscle ratio as a determinant of major complications after pancreatoduodenectomy for cancer. Nutrition. 2016;32(11-12):12311237.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 11

    Dalal S, Hui D, Bidaut L, et al. Relationships among body mass index, longitudinal body composition alterations, and survival in patients with locally advanced pancreatic cancer receiving chemoradiation: a pilot study. J Pain Symptom Manage. 2012;44(2):181191.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 12

    Stephen WC, Janssen I. Sarcopenic-obesity and cardiovascular disease risk in the elderly. J Nutr Health Aging. 2009;13(5):460466.

  • 13

    Prado CMM, Lieffers JR, McCargar LJ, et al. Prevalence and clinical implications of sarcopenic obesity in patients with solid tumours of the respiratory and gastrointestinal tracts: a population-based study. Lancet Oncol. 2008;9(7):629635.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 14

    Zamboni M, Mazzali G, Fantin F, Rossi A, Di Francesco V. Sarcopenic obesity: a new category of obesity in the elderly. Nutr Metab Cardiovasc Dis. 2008;18(5):388395.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 15

    Liu C, Wong PY, Chung YL, et al. Deciphering the "obesity paradox" in the elderly: a systematic review and meta-analysis of sarcopenic obesity. Obes Rev. 2023;24(2):e13534.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 16

    Nater A, Tetreault LL, Davis AM, Sahgal AA, Kulkarni AV, Fehlings MG. Key preoperative clinical Factors predicting outcome in surgically treated patients with metastatic epidural spinal cord compression: results from a survey of 438 AOSpine International members. World Neurosurg. 2016;93:436-448.e15.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 17

    Zakaria HM, Wilkinson BM, Pennington Z, et al. Sarcopenia as a prognostic factor for 90-day and overall mortality in patients undergoing spine surgery for metastatic tumors: a multicenter retrospective cohort study. Neurosurgery. 2020;87(5):10251036.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 18

    MacLean MA, Georgiopoulos M, Charest-Morin R, et al. Perception of frailty in spinal metastatic disease: international survey of the AO Spine community. J Neurosurg Spine. 2023;38(6):715725.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 19

    Coleman RE. Clinical features of metastatic bone disease and risk of skeletal morbidity. Clin Cancer Res. 2006;12(20 Pt 2):6243s6249s.

  • 20

    Bauer H, Tomita K, Kawahara N, Abdel-Wanis ME, Murakami H. Surgical strategy for spinal metastases. Spine (Phila Pa 1976). 2002;27(10):11241126.

  • 21

    MacLean MA, Touchette CJ, Georgiopoulos M, et al. Systemic considerations for the surgical treatment of spinal metastatic disease: a scoping literature review. Lancet Oncol. 2022;23(7):e321e333.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 22

    Rigney GH, Massaad E, Kiapour A, et al. Implication of nutritional status for adverse outcomes after surgery for metastatic spine tumors. J Neurosurg Spine. 2023;39(4):557567.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 23

    Massaad E, Bridge CP, Kiapour A, et al. Evaluating frailty, mortality, and complications associated with metastatic spine tumor surgery using machine learning–derived body composition analysis. J Neurosurg Spine. 2022;37(2):263273.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 24

    Magudia K, Bridge CP, Bay CP, et al. Population-scale CT-based body composition analysis of a large outpatient population using deep learning to derive age-, sex-, and race-specific reference curves. Radiology. 2021;298(2):319329.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 25

    Martin L, Birdsell L, Macdonald N, et al. Cancer cachexia in the age of obesity: skeletal muscle depletion is a powerful prognostic factor, independent of body mass index. J Clin Oncol. 2013;31(12):15391547.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 26

    Carvalho ALM, Gonzalez MC, Sousa IM, et al. Low skeletal muscle radiodensity is the best predictor for short-term major surgical complications in gastrointestinal surgical cancer: a cohort study. PLoS One. 2021;16(2):e0247322.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 27

    Fujioka S, Matsuzawa Y, Tokunaga K, Tarui S. Contribution of intra-abdominal fat accumulation to the impairment of glucose and lipid metabolism in human obesity. Metabolism. 1987;36(1):5459.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 28

    Maskarinec G, Shvetsov YB, Wong MC, et al. Subcutaneous and visceral fat assessment by DXA and MRI in older adults and children. Obesity (Silver Spring). 2022;30(4):920930.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 29

    Mirza SK, Deyo RA, Heagerty PJ, Turner JA, Lee LA, Goodkin R. Towards standardized measurement of adverse events in spine surgery: conceptual model and pilot evaluation. BMC Musculoskelet Disord. 2006;7(1):53.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 30

    Lou N, Chi CH, Chen XD, et al. Sarcopenia in overweight and obese patients is a predictive factor for postoperative complication in gastric cancer: a prospective study. Eur J Surg Oncol. 2017;43(1):188195.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 31

    Nishigori T, Tsunoda S, Okabe H, et al. Impact of sarcopenic obesity on surgical site infection after laparoscopic total gastrectomy. Ann Surg Oncol. 2016;23(suppl 4):524531.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 32

    Malietzis G, Currie AC, Athanasiou T, et al. Influence of body composition profile on outcomes following colorectal cancer surgery. Br J Surg. 2016;103(5):572580.

  • 33

    Baumgartner RN, Heymsfield SB, Roche AF. Human body composition and the epidemiology of chronic disease. Obes Res. 1995;3(1):7395.

  • 34

    Bigaard J, Frederiksen K, Tjønneland A, et al. Body fat and fat-free mass and all-cause mortality. Obes Res. 2004;12(7):10421049.

  • 35

    Heitmann BL, Erikson H, Ellsinger BM, Mikkelsen KL, Larsson B. Mortality associated with body fat, fat-free mass and body mass index among 60-year-old swedish men-a 22-year follow-up. The study of men born in 1913. Int J Obes Relat Metab Disord. 2000;24(1):3337.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 36

    Kobayashi A, Kaido T, Hamaguchi Y, et al. Impact of sarcopenic obesity on outcomes in patients undergoing hepatectomy for hepatocellular carcinoma. Ann Surg. 2019;269(5):924931.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 37

    Mintziras I, Miligkos M, Wächter S, Manoharan J, Maurer E, Bartsch DK. Sarcopenia and sarcopenic obesity are significantly associated with poorer overall survival in patients with pancreatic cancer: systematic review and meta-analysis. Int J Surg. 2018;59:1926.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 38

    Cruz-Jentoft AJ, Baeyens JP, Bauer JM, et al. Sarcopenia: European consensus on definition and diagnosis: report of the European Working Group on Sarcopenia in Older People. Age Ageing. 2010;39(4):412423.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 39

    Frisoli A Jr, Chaves PH, Ingham SJM, Fried LP. Severe osteopenia and osteoporosis, sarcopenia, and frailty status in community-dwelling older women: results from the Women’s Health and Aging Study (WHAS) II. Bone. 2011;48(4):952957.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 40

    Cheung ZB, Vig KS, White SJW, et al. Impact of obesity on surgical outcomes following laminectomy for spinal metastases. Global Spine J. 2019;9(3):254259.

  • 41

    Bourassa-Moreau É, Versteeg A, Moskven E, et al. Sarcopenia, but not frailty, predicts early mortality and adverse events after emergent surgery for metastatic disease of the spine. Spine J. 2020;20(1):2231.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 42

    Kalinkovich A, Livshits G. Sarcopenic obesity or obese sarcopenia: a cross talk between age-associated adipose tissue and skeletal muscle inflammation as a main mechanism of the pathogenesis. Ageing Res Rev. 2017;35:200221.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 43

    Scott D, Shore-Lorenti C, McMillan L, et al. Associations of components of sarcopenic obesity with bone health and balance in older adults. Arch Gerontol Geriatr. 2018;75:125131.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 44

    Krenzlin H, Schmidt L, Jankovic D, et al. Impact of sarcopenia and bone mineral density on implant failure after dorsal instrumentation in patients with osteoporotic vertebral fractures. Medicina (Kaunas). 2022;58(6):748.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 45

    Laufer I, Rubin DG, Lis E, et al. The NOMS framework: approach to the treatment of spinal metastatic tumors. Oncologist. 2013;18(6):744751.

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