{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,3]],"date-time":"2026-02-03T00:40:51Z","timestamp":1770079251888,"version":"3.49.0"},"reference-count":47,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2026,2,1]],"date-time":"2026-02-01T00:00:00Z","timestamp":1769904000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Background and Objectives: Rapid physiological decline in terminal cancer is frequently accompanied by accelerated skeletal muscle loss. Although bedside ultrasonography (US) is practical and feasible in palliative care settings, the prognostic relevance of short-term muscle change remains unclear. This study aimed to evaluate whether the rate of muscle loss over a 10-day period, assessed by serial ultrasound, is associated with survival duration in terminally ill cancer patients. Materials and Methods: This single-center retrospective cohort study included 87 inpatients with end-stage cancer who underwent bedside ultrasound measurements of the biceps brachii (BB) and rectus femoris (RF). Baseline US was performed within the first three days of admission, followed by a repeat assessment 10 days after baseline (day-10 follow-up ultrasound). Muscle thickness (MT) measurements were normalized by height squared (m2), and 10-day changes were calculated as delta (\u0394) indices, defined as baseline minus day-10 values. Because the exposure of interest (\u0394) can only be determined after completion of the day-10 assessment, survival timing analyses were anchored to this prespecified landmark. Survival duration was defined as the number of days from the day-10 follow-up ultrasound to death among patients who died within one year. Associations between muscle changes and survival duration were evaluated using correlation analyses and multivariable linear regression adjusted for age, sex, body mass index, Eastern Cooperative Oncology Group (ECOG) performance status, and nutritional risk. The primary analyses focused on survival timing among decedents. Results: Significant muscle loss was observed over the 10-day interval between baseline and 10 days after baseline. Among the 58 patients who died within one year, greater short-term biceps muscle loss, reflected by higher \u0394 BB muscle thickness index (\u0394 BB MT-I), was moderately associated with shorter survival duration (r = \u22120.437, p = 0.0006). In multivariable linear regression analysis, \u0394 BB MT-I remained independently associated with survival duration (\u03b2 = \u2212701.19; 95% CI: \u22121102 to \u2212301; p = 0.0006), whereas RF muscle changes and baseline clinical variables were not statistically significant. Conclusions: Short-term biceps muscle loss assessed by serial ultrasound, as reflected by \u0394 BB MT-I, is associated with shorter survival duration in terminally ill cancer patients. These findings suggest that dynamic muscle changes, rather than single-time-point measurements, may provide clinically meaningful insight into short-term survival timing. Serial bedside muscle ultrasound may serve as a low-burden adjunct for prognostic communication in palliative care, although prospective time-to-event studies are required for validation.<\/jats:p>","DOI":"10.3390\/medicina62020292","type":"journal-article","created":{"date-parts":[[2026,2,2]],"date-time":"2026-02-02T12:49:44Z","timestamp":1770036584000},"page":"292","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Short-Term Biceps Muscle Wasting Assessed by Serial Ultrasound as a Predictor of Survival Duration in Terminally Ill Cancer Patients: A Retrospective Cohort Study"],"prefix":"10.3390","volume":"62","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3806-5291","authenticated-orcid":false,"given":"\u0130rem","family":"K\u0131ra\u00e7 Utku","sequence":"first","affiliation":[{"name":"Division of Geriatrics, Department of Internal Medicine, Tekirdag Ismail Fehmi Cumalioglu City Hospital, Tekirdag 59030, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2494-1625","authenticated-orcid":false,"given":"Nezahat M\u00fcge","family":"\u00c7at\u0131kka\u015f","sequence":"additional","affiliation":[{"name":"Division of Geriatrics, Department of Internal Medicine, Sancaktepe Martyr Prof. Dr. Ilhan Varank Training and Research Hospital, Istanbul 34785, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7467-1112","authenticated-orcid":false,"given":"Deniz Sevindik","family":"G\u00fcnay","sequence":"additional","affiliation":[{"name":"Division of Geriatrics, Department of Internal Medicine, Fatih Sultan Mehmet Training and Research Hospital, Istanbul 34752, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0396-7802","authenticated-orcid":false,"given":"Ayfer","family":"Durak","sequence":"additional","affiliation":[{"name":"Division of Geriatrics, Department of Internal Medicine, Amasya Sabuncuoglu Serefeddin Training and Research Hospital, Amasya 05100, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5720-8254","authenticated-orcid":false,"given":"Burcu","family":"G\u00fclba\u011fc\u0131","sequence":"additional","affiliation":[{"name":"Division of Oncology, Department of Internal Medicine, Tekirdag Ismail Fehmi Cumalioglu City Hospital, Tekirdag 59030, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9763-4370","authenticated-orcid":false,"given":"Umut","family":"Safer","sequence":"additional","affiliation":[{"name":"Division of Geriatrics, Department of Internal Medicine, Sancaktepe Martyr Prof. Dr. Ilhan Varank Training and Research Hospital, Istanbul 34785, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,2,1]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"382","DOI":"10.1016\/j.tem.2021.03.007","article-title":"Cancer-mediated muscle cachexia: Etiology and clinical management","volume":"32","author":"Siff","year":"2021","journal-title":"Trends Endocrinol. Metab."},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Mariean, C.R., Tiuc\u0103, O.M., Mariean, A., and Cotoi, O.S. (2023). Cancer cachexia: New insights and future directions. Cancers, 15.","DOI":"10.3390\/cancers15235590"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"e13516","DOI":"10.1111\/apha.13516","article-title":"Pathophysiological mechanisms explaining poor clinical outcome of older cancer patients with low skeletal muscle mass","volume":"231","author":"Looijaard","year":"2021","journal-title":"Acta Physiol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1413","DOI":"10.1002\/jcsm.12633","article-title":"Cancer cachexia and skeletal muscle atrophy in clinical studies: What do we really know?","volume":"11","author":"Dolly","year":"2020","journal-title":"J. Cachexia Sarcopenia Muscle"},{"key":"ref_5","first-page":"732","article-title":"Kanserli hastada sarkopeniye g\u00fcncel bak\u0131\u015f","volume":"7","author":"Toruk","year":"2023","journal-title":"Adnan Menderes Univ. Sa\u011fl\u0131k Bilim. Derg."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1151.e9","DOI":"10.1016\/j.jcrc.2015.05.024","article-title":"Ultrasonography in the intensive care setting can be used to detect changes in the quality and quantity of muscle and is related to muscle strength and function","volume":"30","author":"Parry","year":"2015","journal-title":"J. Crit. Care"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1591","DOI":"10.1001\/jama.2013.278481","article-title":"Acute skeletal muscle wasting in critical illness","volume":"310","author":"Puthucheary","year":"2013","journal-title":"JAMA"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1512","DOI":"10.1002\/jcu.23571","article-title":"Biceps brachii muscle cross-sectional area measured by ultrasonography is independently associated with one-month mortality: A prospective observational study","volume":"51","author":"Catikkas","year":"2023","journal-title":"J. Clin. Ultrasound"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"e677","DOI":"10.1016\/j.jpainsymman.2023.01.010","article-title":"Characteristics of untreated cancer patients admitted to an acute supportive\/palliative care unit","volume":"65","author":"Mercadante","year":"2023","journal-title":"J. Pain Symptom Manag."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"195","DOI":"10.1136\/bmj.327.7408.195","article-title":"A systematic review of physicians\u2019 survival predictions in terminally ill cancer patients","volume":"327","author":"Glare","year":"2003","journal-title":"BMJ"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"526","DOI":"10.1136\/spcare-2023-004669","article-title":"Mortality rate and palliative sedation in an acute palliative care unit","volume":"15","author":"Mercadante","year":"2025","journal-title":"BMJ Support. Palliat. Care"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"240","DOI":"10.1016\/S0885-3924(98)00146-8","article-title":"Successful validation of the palliative prognostic score in terminally ill cancer patients","volume":"17","author":"Maltoni","year":"1999","journal-title":"J. Pain Symptom Manag."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"17105","DOI":"10.1038\/nrdp.2017.105","article-title":"Cancer-associated cachexia","volume":"4","author":"Baracos","year":"2018","journal-title":"Nat. Rev. Dis. Primers"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1662","DOI":"10.1111\/1759-7714.13958","article-title":"Longitudinal changes in skeletal muscle mass in patients with advanced squamous cell lung cancer","volume":"12","author":"Lee","year":"2021","journal-title":"Thorac. Cancer"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"629","DOI":"10.1016\/S1470-2045(08)70153-0","article-title":"Prevalence and clinical implications of sarcopenic obesity in patients with solid tumours","volume":"9","author":"Prado","year":"2008","journal-title":"Lancet Oncol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"90","DOI":"10.1200\/JCO.2014.56.1894","article-title":"Diagnostic criteria for the classification of cancer-associated weight loss","volume":"33","author":"Martin","year":"2015","journal-title":"J. Clin. Oncol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"489","DOI":"10.1016\/S1470-2045(10)70218-7","article-title":"Definition and classification of cancer cachexia: An international consensus","volume":"12","author":"Fearon","year":"2011","journal-title":"Lancet Oncol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"742","DOI":"10.1038\/s41598-023-28071-8","article-title":"Incidence of muscle wasting in the critically ill: A prospective observational cohort study","volume":"13","author":"Hrdy","year":"2023","journal-title":"Sci. Rep."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"702","DOI":"10.1002\/jcsm.12210","article-title":"The reliability and validity of ultrasound to quantify muscles in older adults","volume":"8","author":"Nijholt","year":"2017","journal-title":"J. Cachexia Sarcopenia Muscle"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"557","DOI":"10.3904\/kjim.2022.308","article-title":"Predictors of 3-month mortality with muscle ultrasound and palliative prognostic tools","volume":"38","author":"Kaya","year":"2023","journal-title":"Korean J. Intern. Med."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"29912","DOI":"10.1038\/s41598-025-15995-6","article-title":"Muscle thickness from amplitude mode ultrasound and clinical outcomes in patients with cancer","volume":"15","author":"Bennemann","year":"2025","journal-title":"Sci. Rep."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"62","DOI":"10.1002\/mus.10386","article-title":"Muscle fiber number in the biceps brachii muscle of young and old men","volume":"28","author":"Klein","year":"2003","journal-title":"Muscle Nerve"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"e14732","DOI":"10.7717\/peerj.14732","article-title":"Characteristics of muscle contraction of the rectus femoris using tensiomyography by sex","volume":"11","author":"Kusumoto","year":"2023","journal-title":"PeerJ"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"81","DOI":"10.1002\/ca.24091","article-title":"Sex differences in skeletal muscle fiber types: A meta-analysis","volume":"37","author":"Nuzzo","year":"2024","journal-title":"Clin. Anat."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"412","DOI":"10.1093\/ageing\/afq034","article-title":"Sarcopenia: European consensus on definition and diagnosis","volume":"39","author":"Baeyens","year":"2010","journal-title":"Age Ageing"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"95","DOI":"10.1016\/j.jamda.2013.11.025","article-title":"Sarcopenia in Asia: Consensus report","volume":"15","author":"Chen","year":"2014","journal-title":"J. Am. Med. Dir. Assoc."},{"key":"ref_27","doi-asserted-by":"crossref","unstructured":"Hogenbirk, R.N.M., Viddeleer, A.R., Hentzen, J.E.K.R., van der Plas, W.Y., van der Schans, C.P., de Bock, G.H., Kruijff, S., and Klaase, J.M. (2022). Thickness of biceps and quadriceps femoris muscle measured using point-of-care ultrasound. J. Clin. Med., 11.","DOI":"10.3390\/jcm11226606"},{"key":"ref_28","first-page":"e0000776","article-title":"Assessment of sarcopenia in cirrhosis","volume":"31","author":"Cespedes","year":"2025","journal-title":"Liver Transplant."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"109676","DOI":"10.1016\/j.ejso.2025.109676","article-title":"Ultrasound for skeletal muscle assessment in surgical oncology","volume":"51","author":"Vongchaiudomchoke","year":"2025","journal-title":"Eur. J. Surg. Oncol."},{"key":"ref_30","first-page":"354","article-title":"Monitoring muscle mass using ultrasound","volume":"27","author":"Stapel","year":"2021","journal-title":"Curr. Opin. Crit. Care"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"57","DOI":"10.1002\/jcsm.13149","article-title":"Diagnostic test accuracy of ultrasound for sarcopenia diagnosis","volume":"14","author":"Fu","year":"2023","journal-title":"J. Cachexia Sarcopenia Muscle"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"569","DOI":"10.1016\/j.clnesp.2023.07.089","article-title":"Ultrasound-based upper limb muscle thickness for screening low muscularity","volume":"57","author":"Nakanishi","year":"2023","journal-title":"Clin. Nutr. ESPEN"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"104219","DOI":"10.1016\/j.numecd.2025.104219","article-title":"Prognostic value of ultrasound-assessed upper limb muscle thickness","volume":"35","author":"Noda","year":"2025","journal-title":"Nutr. Metab. Cardiovasc. Dis."},{"key":"ref_34","doi-asserted-by":"crossref","unstructured":"Pardo, E., El Behi, H., Boizeau, P., Verdonk, F., Alberti, C., and Lescot, T. (2018). Reliability of ultrasound measurements of quadriceps muscle thickness. BMC Anesthesiol., 18.","DOI":"10.1186\/s12871-018-0647-9"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"781","DOI":"10.4103\/ijccm.IJCCM_394_18","article-title":"Point-of-care ultrasound to evaluate rectus femoris thickness","volume":"22","author":"Katari","year":"2018","journal-title":"Indian J. Crit. Care Med."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"b5087","DOI":"10.1136\/bmj.b5087","article-title":"Problem of immortal time bias in cohort studies","volume":"340","author":"Hanley","year":"2010","journal-title":"BMJ"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"2963","DOI":"10.1200\/JCO.2013.49.5283","article-title":"Challenges of guarantee-time bias","volume":"31","author":"Gelber","year":"2013","journal-title":"J. Clin. Oncol."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"758","DOI":"10.1093\/aje\/kwv254","article-title":"Using big data to emulate a target trial when a randomized trial is not available","volume":"183","author":"Robins","year":"2016","journal-title":"Am. J. Epidemiol."},{"key":"ref_39","first-page":"m441","article-title":"Calculating the sample size required for developing a clinical prediction model","volume":"368","author":"Riley","year":"2019","journal-title":"BMJ"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"128","DOI":"10.1097\/EDE.0b013e3181c30fb2","article-title":"Assessing the performance of prediction models","volume":"21","author":"Steyerberg","year":"2010","journal-title":"Epidemiology"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"619","DOI":"10.1002\/jcsm.12528","article-title":"Cancer cachexia and its pathophysiology","volume":"11","author":"Santos","year":"2020","journal-title":"J. Cachexia Sarcopenia Muscle"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"793","DOI":"10.1016\/j.clnu.2008.06.013","article-title":"Cachexia: A new definition","volume":"27","author":"Evans","year":"2008","journal-title":"Clin. Nutr."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"2947","DOI":"10.7150\/ijms.49637","article-title":"Ultrasound for measuring cross-sectional area of biceps brachii","volume":"17","author":"Li","year":"2020","journal-title":"Int. J. Med. Sci."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"10","DOI":"10.1007\/s44349-024-00010-0","article-title":"Ultrasound-guided evaluation of muscle wasting in critically ill patients","volume":"11","author":"Ali","year":"2024","journal-title":"Egypt. J. Crit. Care Med."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"873","DOI":"10.1016\/j.aucc.2024.03.007","article-title":"Ultrasound-derived rates of muscle wasting","volume":"37","author":"Rollinson","year":"2024","journal-title":"Aust. Crit. Care"},{"key":"ref_46","doi-asserted-by":"crossref","unstructured":"Kim, M., Kim, S., Ju, Y., Ahn, S., and Lee, S.I. (2024). Evaluating muscle mass changes in critically ill patients. Healthcare, 12.","DOI":"10.3390\/healthcare12212128"},{"key":"ref_47","first-page":"122","article-title":"Ultrasound monitoring of skeletal muscle wasting","volume":"13","author":"Rodeia","year":"2025","journal-title":"Intensive Care Med. Exp."}],"container-title":["Medicina"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1648-9144\/62\/2\/292\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,2,2]],"date-time":"2026-02-02T13:23:56Z","timestamp":1770038636000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1648-9144\/62\/2\/292"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,2,1]]},"references-count":47,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2026,2]]}},"alternative-id":["medicina62020292"],"URL":"https:\/\/doi.org\/10.3390\/medicina62020292","relation":{},"ISSN":["1648-9144"],"issn-type":[{"value":"1648-9144","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,2,1]]}}}