Can Psoas muscle density predict the development of metastasis in non-metastatic adrenocortical carcinomas?: A CT-based AI-assisted automated segmentation analysis study

Year 2024, Volume: 7 Issue: 3, 175 - 178, 30.09.2024

Emin Demırel , Okan Dılek

https://doi.org/10.36516/jocass.1532122

Abstract

Aim: Our study aimed to investigate whether artificial intelligence-based body composition analysis can predict metastasis development during follow-up in patients with non-metastatic adrenocortical carcinoma (ACC) at the time of diagnosis.
Methods: Forty-five patients with non-metastatic ACC were included at the time of diagnosis. From the patients' non-contrast computed tomography (CT) scans, visceral adipose tissue (VAT), subcutaneous adipose tissue (SAT), psoas area, psoas density, total muscle area, and total muscle density were automatically measured from sections taken at the level of the inferior endplate of the L3 vertebra. Patients were followed for developing liver, lung, and lymph node metastases. The relationship between body composition and liver and lymph node metastasis development was investigated. Propensity score matching (PSM) was performed for patients with metastases.
Results: Forty-five patients, 27 of whom were female, with non-metastatic ACC at the time of diagnosis, were included in the study. The mean age of the patients was 53±17.4 years. Significant differences were found between the groups that developed liver metastases and those that did not, and between the groups that developed lymph node metastases and those that did not, in terms of correct Psoas HU, left Psoas HU, PMD, Wall Muscle HU, and age (p<0.05). After applying PSM based on age, sex, and T stage, the odds ratio for psoas muscle density in predicting liver metastasis was found to be 0.898, 95% CI(0.828-0.973) in the logistic regression analysis.
Conclusion: Psoas muscle density may be a potential biomarker for predicting metastasis development in patients with non-metastatic ACC.

Keywords

Adrenocortical carcinoma, sarcopenia, metastasis, psoas muscle density, adipose tissue

References

• 1.Thampi A, Shah E, Elshimy G, et al. Adrenocortical carcinoma: a literature review. Translational Cancer Research, 2020;9:1253-64. https://doi.org/10.21037/tcr.2019.12.28
• 2.Sharma E, Dahal S, Sharma P, et al. The characteristics and trends in adrenocortical carcinoma: a United States population based study. J Clin Med Res. 2018;10:636-40. https://doi.org/10.14740/jocmr3503w
• 3.Tella SH, Kommalapati A, Yaturu S, et al. Predictors of survival in adrenocortical carcinoma: an analysis from the national cancer database. J Clin Endocrinol Metab. 2018;103:3566-73. https://doi.org/10.1210/jc.2018-00918
• 4.Hermsen IG, Gelderblom H, Kievit J, et al. Extremely long survival in six patients despite recurrent and metastatic adrenal carcinoma. Eur J Endocrinol. 2008;158:911-9. https://doi.org/10.1530/EJE-07-0723
• 5.Assié G, Antoni G, Tissier F, et al. Prognostic parameters of metastatic adrenocortical carcinoma. J Clin Endocrinol Metab. 2007;92:148-54. https://doi.org/10.1210/jc.2006-0706
• 6.Alyateem, G. and N. Nilubol, Current status and future targeted therapy in adrenocortical cancer. Frontiers in Endocrinology, 2021:12: p. 613248. https://doi.org/10.3389/fendo.2021.613248
• 7.Pegna GJ, Roper N, Kaplan RN,et al. The Immunotherapy Landscape in Adrenocortical Cancer. Cancers (Basel). 2021;13:2660. https://doi.org/10.3390/cancers13112660
• 8.Fassnacht M, Kroiss M, Allolio B. Update in adrenocortical carcinoma. J Clin Endocrinol Metab. 2013;98):4551-64. https://doi.org/10.1210/jc.2013-3020
• 9.Pamoukdjian F, Bouillet T, Lévy V,et al. Prevalence and predictive value of pre-therapeutic sarcopenia in cancer patients: A systematic review. Clin Nutr. 2018 ;37:1101-13. https://doi.org/10.1016/j.clnu.2017.07.010
• 10.Cruz-Jentoft AJ, Romero-Yuste S, Chamizo Carmona E, et al. Sarcopenia, immune-mediated rheumatic diseases, and nutritional interventions. Aging Clin Exp Res. 2021 ;33:2929-39. Https://doi.org/10.1007/s40520-021-01800-7
• 11.Miller BS, Ignatoski KM, Daignault S, et al. University of Michigan Analytical Morphomics Group. Worsening central sarcopenia and increasing intra-abdominal fat correlate with decreased survival in patients with adrenocortical carcinoma. World J Surg. 2012;36:1509-16. https://doi.org/10.1007/s00268-012-1581-5
• 12.de Jong MC, Patel N, Hassan-Smith Z, et al. Sarcopenia is Associated with Reduced Survival following Surgery for Adrenocortical Carcinoma. Endocr Res. 2022 ;47:8-17. https://doi.org/10.1080/07435800.2021.1954942
• 13.Mullie L, Afilalo J. CoreSlicer: A web toolkit for analytic morphomics. BMC Med Imaging. 2019;19:15. https://doi.org/10.1186/s12880-019-0316-6
• 14.Thoemmes, F., Propensity score matching in SPSS. arXiv preprint arXiv:1201.6385, 2012. 15.Williams GR, Dunne RF, Giri S, et al. Sarcopenia in the Older Adult With Cancer. J Clin Oncol. 2021;39:2068-78. https://doi.org/10.1200/JCO.21.00102
• 16.Peixoto da Silva S, Santos JMO, Costa E Silva MP, et al. Cancer cachexia and its pathophysiology: links with sarcopenia, anorexia and asthenia. J Cachexia Sarcopenia Muscle. 2020;11:619-35. https://doi.org/10.1002/jcsm.12528
• 17.Santhanam P, Dinparastisaleh R, Popuri K,et al. Fully-automated CT derived body composition analysis reveals sarcopenia in functioning adrenocortical carcinomas. Sci Rep. 2024;14:12193. https://doi.org/10.1038/s41598-024-62431-2