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Sarcopenia in Children With Wilms Tumor: A Marker of Undernutrition Which May Impact Adversely on Clinical Outcomes
Wilson E de Oliveira1,2, Mariana S Murra3, Leticia M B Tufi2
1Departments of Pediatric Surgery.
Insights
Children with Wilms tumor (WT) experience significant muscle loss, known as sarcopenia, during cancer treatment. This study tracked total psoas muscle area (TPMA) and found high rates of sarcopenia persisting even one year after surgery.
Area of Science:
- Pediatric Oncology
- Medical Imaging
- Nutritional Science
Background:
- Wilms tumor (WT) treatment is intensive, leading to nutritional challenges and potential malnutrition in children.
- Sarcopenia, muscle loss, is a recognized adverse effect of cancer therapy in pediatric patients.
- Reduced total psoas muscle area (TPMA) is linked to poorer outcomes in pediatric diseases, including cancer.
Purpose of the Study:
- To investigate changes in the total psoas muscle area (TPMA) during Wilms tumor (WT) treatment in children.
- To assess the incidence and progression of sarcopenia in pediatric WT patients throughout their therapeutic journey.
Main Methods:
- An observational, longitudinal, retrospective study involving 38 children (ages 1-14) with WT.
- TPMA was evaluated using computed tomography (CT) scans at diagnosis, pre-surgery, and 1 year post-surgery.
- TPMA/age Z-scores were calculated to quantify muscle mass changes relative to age.
Main Results:
- A high prevalence of sarcopenia (55.3%) was observed at diagnosis.
- Sarcopenia increased to 73.7% after neoadjuvant chemotherapy and remained elevated at 78.9% one year post-surgery.
- Significant and rapid muscle loss was detected, with minimal recovery observed within the study period.
Conclusions:
- Children undergoing Wilms tumor treatment exhibit substantial muscle depletion (sarcopenia) that persists long-term.
- Monitoring TPMA is crucial for understanding the impact of cancer therapy and identifying patients at risk.
- Further research into interventions to mitigate sarcopenia in pediatric cancer patients is warranted.
Abstract:
The therapeutic approach to Wilms tumor (WT) is multidisciplinary and leads to significant patient impairment, increasing the risk of nutritional compromise and malnutrition. Children with cancer are vulnerable to sarcopenia which has been recognized as a negative impact of anticancer therapy. Recent studies have highlighted the reduction in the total psoas muscle area (TPMA) to be associated with a poor prognosis in many pediatric diseases, including cancer. This study aims to evaluate changes in the TPMA compartment during the treatment of children with WT. An observational, longitudinal, and retrospective study was undertaken in a single institution evaluating children (1 to 14 y, n=38) with WT between 2014 and 2020. TPMA was assessed by the analysis of previously collected, electronically stored computed tomography images of the abdomen obtained at 3 time points: diagnosis, preoperatively, and 1 year after surgery. For all patients, TPMA/age were calculated with a specific online calculator. Our data show a high incidence of sarcopenia (55.3%) at diagnosis which increased after 4 to 6 weeks of neoadjuvant chemotherapy (73.7%) and remained high (78.9%) 1 year after the surgical procedure. Using TPMA/age Z-score curves we have found significant and rapid muscle loss in children with WT, with little or no recovery in the study period.
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