Imaging-based skeletal muscle quality and clinical outcomes in Indian older patients with cancer: A retrospective analysis.

Objectives: Computer tomography (CT) measurements of cross-sectional area and density reflect muscle performance and function, but their use is limited in practice. We aimed to evaluate the association of CT-based skeletal muscle quality (qSMQ) with geriatric assessment (GA) and outcomes in older Indian patients with cancer.

Methods: Retrospective observational study in the geriatric oncology clinic in Mumbai, India. Patients aged ≥60 years with cancer who had undergone GA and had CT scan were included. To evaluate skeletal muscle quality, region of interest was drawn on bilateral paraspinal muscle at L3 vertebral level, one section above and below.

Results: Between June 2018 and November 2021, 277 patients were included. At a median follow-up of 23.8 (21.4-28.4) months, 174 deaths had occurred. Using the lower quartile as a cutoff to define poor and good qSMQ, the median overall survivals were 10.7 and 17.5 months in the patients with poor and good qSMQ, respectively (P = 0.124), which was significant after adjusting for body mass index (BMI), primary tumor, metastasis, and performance status (hazard ratio (HR): 1.53; 1.08-2.18, P = 0.017). The likelihood ratio test (LR-test) comparing the full model (qSMQ with nested model) with the nested model (age, sex, BMI, primary tumor, performance status) found that the addition of qSMQ was a significantly better fit (P = 0.015).

Discussion: The utilization of CT scans for older Indian patients with cancer is an effective and crucial means of evaluating skeletal muscle quality. It is closely associated with anthropometric measures, frailty, and overall survival (OS).